Outpatient death charts

katysuegood@gmail.comkatysuegood@gmail.com
in CDI Talk Archive
This may be a stupid question, but here I go. I have been reviewing all our death charts for almost 2 years now for SOI/ROM and DRG assignment. When this process was initiated I was brand new to the facility and CDI. At that time, I was told that all death occurring in the hospital we inpatients. Meaning, if a patient was in OBS status or in the ED, they were changed to IP when they died. I have since found out that this is not true.
I am assuming this is standard but I’m hoping someone can verify this for me?
Also, for those who review death charts, do you review outpatient/ED deaths as well or only inpatient?

Thanks!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

Comments

  • Unknown
    edited May 2016
    Katy,

    I review all our inpt deaths.
    I do not believe our ED/obs deaths are converted to inpt, those I do not review.


    Charlene

  • parrispa@musc.eduparrispa@musc.edu
    edited May 2016
    We only review inpatient deaths in our hospital.
    pam

    Pamela Parris,RN
    Clinical Documentation Integrity
    MUSC
    Charleston, South Carolina 29425
    Pager: 12295
    (843) 792-3442
    MAIN HOSPITAL

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Thanks for everyones responses.

    Melissa, do you find reviewing the OP/ED deaths helpful?

    Thanks!


    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


  • Unknown
    edited May 2016
    This discussion is very timely in my world. I just recently started reviewing death charts. We had a patient admitted to the ICU and expired 1 hour later. The only documentation to code from was the ER. Final coding - GI bleed w/CC. Ancillary documentation noted pt sent from NH due to cyanosis and dyspnea. The paramedics called it respiratory failure, pt went into V-tach when loaded into the rig - Amiodarone started through an IO. The ER nurse initial note: Resp distress, grunting, supra sterna retractions. SpO2 86 on 10 liters O2. Pt DNR so started on BiPAP. ABG's: pH 6.98, PO2 68. WBC 46.1, urine brown, cloudy, loaded with bacteria. BUN 70, creatinine 2.8. Hgb 7.5, Hct 26.7.

    GI bleed w/CC - REALLY??

    Obviously, I have some job security...

    Thanks for letting me vent. :)


    Linnea Thennes, RN, BS, CCDS
    Supervisor, Clinical Documentation Improvement
    Centegra Health System
    815. 759-8193
    lthennes@centegra.com



  • Unknown
    edited May 2016
    Isn't our documentation something?
    I recently review a record whom upon arrival to the unit from ER was not breathing and was pronounced 5 minutes later (a DNR).
    One must really dig to find SOI/ROM.


    Charlene


  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Yup. We have definitely seen improvement but I have a similar one on hold with my MD advisor, as I am hoping he can get the intensivist to write a note on the patient so we can make some changes prior to it being billed.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    Regarding the definition used to compute the observed/expected mortality ratio, it is my understanding ONLY 'inpatients' are included. If a patient expires in the ED prior to an order to admit, the case is excluded.

    Here is the definition we use in our region:


    Acute Care Admission Mortality Ratio (Observed/Expected)

    Definition: Acute Care Admissions Mortality ratio is the APR-DRG risk-adjusted ratio of observed/expected deaths for acute inpatient admissions based on the MIDAS DataVision benchmark. Results are compared to the MIDAS “universe” standardized O/E mortality ratio (1.0). A ratio of 1.0 means that a hospital’s mortality is average in comparison to the national MIDAS Comparative Database (CDB) comprising more than 600 hospitals. Below 1.0 means that the mortality rate is lower than the average performance of the comparative group and above 1.0 means that the hospital’s mortality is higher than the average performance of the comparative group/database.
    Numerator: Observed deaths.
    Denominator: Expected deaths.
    Measurement Calculation: Numerator divided by denominator.
    Data Source: MIDAS DataVision Hospital APR-DRG Ranking Report.
    Benchmark Goal Source: MIDAS DataVision web application comparison population for the standardized mortality ratio benchmark of 1.0. This is based on the concurrent period MIDAS comparative database of approximately 100,000,000 encounters from more than 600 hospitals nationally.

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Thanks Paul. Great info! This was going to be my next question.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited May 2016
    We only review expired cases for acute admissions - if no order to admit and not inpatient status, we do not review.

    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002
    Fax:  415.600.1325
    Ofc:  415.600.3739
    evanspx@sutterhealth.org


  • dvitalone1dvitalone1
    edited May 2016
    We review all inpatient deaths without a CC/MCC


    Dawn M. Vitalone, RN, CCDS
  • mdomineseymdominesey
    edited May 2016
    Yes, I get these kind of cases too! It doesn't look good with reporting agencies for hospitals to have patients die with a low SOI and ROM. This is a perfect argument for getting administrators to understand that it is not just about the money.

    You don't want many patients dying with a SOI/ROM lower than 3/3, 3/4, 4/3 or 4/4.

    Mark


    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital
    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695
    W: 202.660.6782
    http://www.sibley.org
    mdominesey@sibley.org
  • judithbatesjudithbates
    edited May 2016
    for those of us who don't have access to SOI/ROM information...Is there a formula or certain conditions that raise SOI/ROM. I know the encoder provides that info but we don't have those goodies. I know I have seen charts that have conditions that raise SOI/ROM...Would be interested to hear how others are doing with this subject.
    THANKS!Judi Bates

  • dvitalone1dvitalone1
    edited May 2016
    We don't have any way of calculating SOI/ROM@ this time. Dx that raise SOI/ROM depends on the DRG/Pdx but almost always a death case should have at least a CC/MCC so that is what we track.



  • Unknown
    edited May 2016
    I have the grouper. Just an FYI: I have found that acute renal failure is a major severity/ROM driver.

    There really does not seem to by much rhythm or reason. Another one which seems to drive SOI is oliguria.

    Charlene


  • mdomineseymdominesey
    edited May 2016
    Acute Respiratory Failure and Shock are also huge severity drivers.

    Mark


    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital
    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695
    W: 202.660.6782
    http://www.sibley.org
    mdominesey@sibley.org
  • vdavis2vdavis2
    edited May 2016
    Try finding SOI/ROM #'s on a pt that was declared dead at the scene MVC. The pt was intubated and started on life-support in order to try to save her unborn child. Her body was taken straight to the OR in hope to deliver the baby by c-section. The uterus was completely ruptured and "white" when the baby was removed from the uterus. Unfortunately, we did not have any other information regarding the actual injuries other than "head injury and closed injury to the uterus." I think DOA should automatically give you a 4/4 but given the lack of documentation of comorbid conditions and an actual injury report, the case sadly ended up scoring a mere 3/3 for SOI/ROM.

    (This case weighs heavily on all of our hearts! It is just tragic and horrific! Our hearts still mourn for this family! Since I know many of you probably would feel the same way that we do about this case, I felt you would want to know the outcome as well. According to the news reports: The baby was resuscitated after a long period and flown to a major university hospital. The baby had severe head injuries and had no brain activity even after several days. The family's gracious organ donation saved several other infants, so the baby lives on through their gift of life.)

    -Vicki



  • zahnbzahnb
    edited May 2016
    Correct me if I'm wrong, but I don't believe that the SOI/ROM scoring
    applies to outpatients.


    Bonnie Zahn, RHIA, CHP, CHDA
    Director, Health Information Management
    Underwood-Memorial Hospital
    509 N. Broad Street
    Woodbury, New Jersey 08096

    Phone: (856) 853-2112
    Fax: (856) 251-0997
    E-Mail: zahnb@umhospital.org

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