Do any of your programs have a parameter(ie: a 3-4 gram drop in Hbg)to use as a guide as to when to query for Acute Blood Loss Anemia in a patient who has undergone surgery?
This is a curious topic because each case is different. How much did they lose intraop? Is it dilutional? We typically wait >24 hours before asking in surgical patients because it may be dilutional. We don't have a hard and fast rule, but we typically use 9 or less as a guideline.
My thought when reviewing for ABLA is to consider the treatment and the scenario. There are some instances like CABG's where it's a given. The other cases where The drop is sudden, maybe from 14.5 to 10.5 and the patient is suspected of GIB you don't really have to consider a particular number for the hemoglobin drop. Nor do you have to wait until blood products are given. Consider their VS, are they tachy along with their decrease hg??? Hope this helps. BTW...the new 2012 CDI pocket guide has very good reference to ABLA.
Judi Bates RN, BSN, CCDS Our Lady of Lourdes Medical Center CDI Specialist 856-757-3161 Beeper 66x2906
As always it depends on the situation, for example 500cc for a cesarean section isn't much, and would not be replaced. I would consider that integral to the procedure. Other procedures are quite bloody - IE spinal procedures and they may get several units during surgery so that the H&H never drops. You can't query for anemia without anemia.
We must also remember the criteria for definition of a secondary diagnosis...just because patient has a drop in H/H does not necessarily mean that a condition is reportable.
For reporting purposes the definition for “other diagnoses” is interpreted as additional conditions that affect patient care in terms of requiring: clinical evaluation; or therapeutic treatment; or diagnostic procedures; or extended length of hospital stay; or increased nursing care and/or monitoring
Below is a sample of a few of the clinical indicators we refer to when query for ABLA: Significant drop in H&H (AS DEFINED BY FACILITY GUIDELINES) Hypotension Syncope/Dizzy/Light Headed GI Bleeding Acute Bleed – other sites _________________ Palpitations/Rapid Heart Rate Iron Supplements Transfusion(s)
Comments
Jill Lindsey, RN, BSN
Phoenix Children's Hospital
Clinical Documentation Specialist
602-810-4197
Ext. 3-0725
Tracy M Peyton RN, CCDS
Bradford Regional Medical Center
Upper Allegany Health Systems
116 Interstate Parkway
Bradford, PA 16701
814-558-0406
Hope this helps. BTW...the new 2012 CDI pocket guide has very good reference to ABLA.
Judi Bates RN, BSN, CCDS
Our Lady of Lourdes Medical Center
CDI Specialist
856-757-3161
Beeper 66x2906
Elizabeth Hynd RN, BSN, CPUR
Clinical Documentation Specialist
863-687-1100 ext. 7313
For reporting purposes the definition for “other diagnoses” is interpreted as additional conditions that affect patient care in terms of requiring:
clinical evaluation; or
therapeutic treatment; or
diagnostic procedures; or
extended length of hospital stay; or
increased nursing care and/or monitoring
Below is a sample of a few of the clinical indicators we refer to when query for ABLA:
Significant drop in H&H (AS DEFINED BY FACILITY GUIDELINES)
Hypotension
Syncope/Dizzy/Light Headed
GI Bleeding
Acute Bleed – other sites
_________________
Palpitations/Rapid Heart Rate
Iron Supplements
Transfusion(s)
Dorie Douthit, RHIT,CCS