Post op Conditions

jillian.bisbe

Postoperative conditions: For example, pt has open heart surgery. Routinely, the patient is on pressors/support. They are often hypotensive/”shocky” for a brief period of time immediately after surgery.  If an MD documents hypotension, do you capture that? Its inherent to the surgery (no different than an ileus a day or two after GI surgery).

 Example: pt has CABG x4, taken from OR to ICU on Levophed which is weaned off in 3 hours. MD documents hypotension and/OR shock.

Post Op Conditions do not bring me joy.

Thanks!

cdennis

I just went through addressing this issue, and I would be happy to share some information/provider education I researched and developed.  I agree, all these post op conditions are a problem, and especially those that impact PSI's.  My e-mail is cdennis@phs.org, and I will be happy to share my information.  Carol Dennis, RN, BSN, Manager CDI

morris-jeff@CooperHealth.edu

Jillian, I think that’s usually just inherent to those procedures. If it’s what is routinely expected in those patients then it’s not a complication. Would probably be helpful to talk to your CV Surgeons to see what they consider postop shock, do they use pressors routinely coming out of OR to be quickly titrated, etc..

I’ve seen places that would code postop shock and post op heart block in these patients. It seemed as if their MD’s had been instructed to do so (along with post op respiratory failure) because it increased SOI and reimbursement. This was not a practice I agreed with! We’ve always queried when the MD documents post op condition and it doesn’t meet definition of a secondary dx or no indicator that it’s out of the norm for that procedure, etc..

When discussing complications with Providers I always say “it’s complicated”.