S:  As we validate our data and continue to dig deeper and deeper, we find questions we have related to intention of the VTE1 and/or VTE2 measure.  We wanted to inquire about the intention of inclusion or exclusion of SCIP VTE selected surgeries within the VTE assessed encounter. 

B/A:  As we validated, we found sometimes a procedure will start prior to the patient being admitted.  We found that sometimes when they go into the procedure/surgery the provider doesn’t know what status the patient needs at that point in time.  We have found a few different scenarios. 

1. The patient comes in from the emergency department and gets sent to the OR.  The ED provider doesn’t know if the patient will require inpatient care, observation, hospital outpatient etc…. The ED provider doesn’t order an admission yet.  During the procedure the surgeon decides the patient should be an inpatient, patient’s status changed to inpatient at 1/1/21 0425.  However, because the procedure has already begun (time of incision – 1/1/21 0221) the VTE measure doesn’t pick up the included SCIP procedure.  The patient is included in the VTE population and assessed for numerator criteria.  They do not hit the exclusion bucket.  This happens under the same hospital encounter.
2. We have patients who come in as a hospital outpatient or observation status. A patient comes to the hospital as a hospital outpatient and has their included SCIP procedure on 1/1/21.  The patient’s status changes, and the provider admits them to the hospital as an inpatient on 1/2/21 0300.  These patients are included in the VTE population and assessed for numerator criteria and not an exclusion.  This all happens in the same hospital encounter. 

R:  What is the intention of this measure for SCIP procedures being done in the same hospital encounter, but before the patient is formally admitted to the hospital as an inpatient?

See image to CQL connected to this concern.