Performance Measurement Network

Question: SCIP Inf-9 Urinary catheter removed on Postoperative Day 1 (POD 1) or Postoperative Day 2 (POD 2) with day of surgery being day zero

This is follow up to a prior question: "";.

There have been numerous inquiries with respect to the SCIP Inf-9 performance measure that was implemented with discharges effective 10-01-09. Thank you for your input concerning the measure. All feedback is taken into consideration for updates to future manuals.

In response to the questions that are being asked related to SCIP-Inf 9 please see the following answers for some frequently asked questions. Also, please note, questions are being answered as quickly as possible in QUEST, however in the meantime, perhaps this information will be useful.


Data Element - Urinary Catheter:

1) Select Allowable Value 5: if there is no documentation of a catheter being placed intraoperatively (unable to be determined) (Also select Value 5 if no documentation of any catheter during hospitalization.)

2) If the patient had a catheter placed intraoperatively and also there is documentation that the patient had an indwelling (urethral or suprapubic) catheter prior to admission or prior to surgery, select Allowable Value 3.

3) If the patient had a catheter placed intraoperatively and there is documentation that the patient was being intermittently catheterized prior to admission or preoperatively select Allowable Value 4.

4) If there is documentation that a catheter was placed after the patient is out of the operating room such as in the PACU or in the patient's room after PACU, select Allowable Value 2 as there was not documentation that there was a catheter in place immediately postoperatively…instead there is documentation that one was placed immediately postoperatively. Note: To select Value 1 there must be documentation the one was placed in the intraoperative time frame: from the time the patient enters the OR to the time they leave the OR

Data Element - Catheter Removed:

With respect to catheters removed on POD 0 - until we add information about catheters that are removed on the day of surgery, select Allowable Value 1. If there is documentation that the catheter was removed on POD 0, then it was technically out on POD 1 and POD 2.

Data Element - Reasons for Continuing Urinary Catheterization:

For this data element, there must be a reason documented on POD 1 or POD 2 and that reason must be connected to the physician order or to other physician documentation of the plan to continue the catheter. For example: Do not discontinue foley catheter until epidural is out, OR Keep foley until patient is ambulating. This will be sufficient to select Yes.

The Exclusions that cannot be used for Reasons for Continuing Urinary Catheterization are: * Orders to leave the catheter in without a specific reason with the order/plan to leave it in. * Patient refusal of catheter removal * High risk of falls * Reasons documented on POD 0 but not on POD 1 or POD 2.

Remember: the physician documentation must be found on POD 1 or POD 2. Consider the Anesthesia End Date as POD 0. The intent is that the physician will evaluate the patient on POD 1 and POD 2 regarding the necessity for the catheter. Also, one of the most common reasons that urinary catheters are left in place for prolonged periods is that clinicians lose track of the catheter, do not have awareness that it is still in place, and simply do not assess ongoing need.

SCIP Infection 9:

For SCIP-Inf-9, there is currently no exclusion in the event of a patient death after the patient is discharged from PACU and on POD 0 through POD 2, which will be an uncommon situation. The measures specifications are not written to address every possible but uncommon exception to the measure. A scenario like this is the reason the experts do not recommend benchmarks be at 100%.

If there is a patient death on POD 0-POD 2 and the length of stay was less than 2 days, the surgery would be excluded. If the vendor uses SKIP logic it would not have to continue in the algorithm down to Urinary Catheter, Catheter Removed, etc.

If the vendor program does not use SKIP logic, it may require answers to all of the data element questions. In that situation:

a) The abstractor should review the chart for any documentation that might indicate that the catheter was removed such as; all lines were removed after death.

b) If the abstractor does not find any documentation of the catheter being removed, the abstractor will abstract for Value 2 for Catheter Removed.

c) Finally, abstract Reasons to Continue Urinary Catheterization, accordingly. If there was a reason documented, it will exclude the surgery from the measure.

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: SCIP, SCIP Inf-9, Urinary Catheter,

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