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  2. CQM-6860

CMS190 order for ICU vs physical placement

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      Thank you for your inquiry for CMS190 v12: Intensive Care Unit Venous Thromboembolism Prophylaxis. The measure intent is evaluating if ICU patients received VTE prophylaxis, who were admitted or transferred to ICU unit during the encounter. The measure logic "Encounter with ICU Location" is using Facility Location to identify if the patient is physically in ICU, and facility location period to calculate ICU stays. Therefore, an order for ICU Placement should not be used for ICU location evaluation. Here are the responses to your individual questions.

      1). If a patient meets the ""Encounter with ICU Location", this case will be pulled into Denominator population for further evaluation. However, the logic is looking for when the patient was admitted/discharged to/from ICU location.

      2). Again, ORDER for ICU placement is not a right resource field to pull ICU admission /discharge info for measure logic evaluation. In addition, the measure is looking for the ICU stay during the inpatient encounter (not in ED). According to the information provided, this case will not be satisfying the Denominator condition.
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      Thank you for your inquiry for CMS190 v12: Intensive Care Unit Venous Thromboembolism Prophylaxis. The measure intent is evaluating if ICU patients received VTE prophylaxis, who were admitted or transferred to ICU unit during the encounter. The measure logic "Encounter with ICU Location" is using Facility Location to identify if the patient is physically in ICU, and facility location period to calculate ICU stays. Therefore, an order for ICU Placement should not be used for ICU location evaluation. Here are the responses to your individual questions. 1). If a patient meets the ""Encounter with ICU Location", this case will be pulled into Denominator population for further evaluation. However, the logic is looking for when the patient was admitted/discharged to/from ICU location. 2). Again, ORDER for ICU placement is not a right resource field to pull ICU admission /discharge info for measure logic evaluation. In addition, the measure is looking for the ICU stay during the inpatient encounter (not in ED). According to the information provided, this case will not be satisfying the Denominator condition.
    • CMS0190v12
    • Actual record of pt placement does not reflect an ICU stay, but an ICU order is pulling the case into the DEN and VTE prophylaxis administration is pulling the case into the NUM category. If validated, could this case be a mismatch?

      in reviewing results for VTE2 at a particular facility, I have a patient that had an ORDER for ICU placement while in the ED.  The patient never was physically on an Intensive Care Unit, but remained in the ED, before transferring out of the ED to a step-down unit.  The QRDA file is reflecting an ICU stay from the time of the order (0012)) to the time the patient left the ED (1255-same day) for the step-down unit. 

      The record does not reflect an ICU status at any time, but the order for the ICU stay is what's pulling this particular case into the Denominator.  And, in fact, the patient did receive VTE prophylaxis during the time period the QRDA file is reflecting the "ICU" stay, and so is ultimately falling into the Numerator category. 

      1) in terms of "Encounter with ICU Location" is it correct that the case should be pulled into the DEN category based on the order alone even though the patient was never physically in the ICU and the record only shows registration to the ED and a step-down unit?

      2) if selected for validation, if the case a) does not reflect a physical stay in the ICU, but only an order for an ICU admission and b) a QRDA file that is recognizing an "ICU" stay during the time the patient was in the ED until transfer out to the Step-down unit, will this case be considered a mismatch for VTE2?

            JLeflore Joelencia Leflore
            shorca Cari Ann Jones
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