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Type:
Hosp Inpt eCQMs - Hospital Inpatient eCQMs
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Resolution: Answered
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Priority:
Moderate
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Component/s: None
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None
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Tammie Trefz
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785-331-9973
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CommonSpirit Health
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CMS0190v13
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Accurate location logic
An organization has a unit with "ICU" in the name. The organization has made the decision to use this unit to care for telemetry patients that are overflow from another unit and state no ICU patients are being taken care of on this unit.
They state "We have a program flex through the health department for this location to be Telemetry. " Hospital will place of telemetry patients in (unit name) - in consideration of infection prevention and health and safety of the patients and others in each room. The patients in this area will be under the oversight of nursing and medical leadership for telemetry services."
In review of the guidance in the VTE-02 specifications, "The definition of an ICU for the purpose of the measures noted above is that used by the CDC in the NHSN Patient Safety Project. An intensive care unit can be defined as a nursing care area that provides intensive observation, diagnosis, and therapeutic procedures for adults and/or children who are critically ill. An ICU excludes nursing areas that provide step-down, intermediate care or telemetry only and specialty care areas."
With this information, is it appropriate to adjust mapping of this location so that it is not considered an ICU location by the VTE-1 and VTE-2 measure logic, even though it has "ICU" in the name?
Additionally, if appropriate to change mapping of this location so that it is not considered an ICU location, and the organization is selected for validation, would additional information need to be provided to CDAC for each VTE case that was in this location?
Thank you