Question

Tracking and evaluating patient care is a key function to providing quality care. A major issue in patient care are infections, both community-acquired and nosocomial. The Infection Control department of Lewis-Beck Medical Center thinks there is an increase in the number and types of patients who develop sepsis during their hospital stay. The number of patients who die from sepsis have an impact on the mortality rate of LBMC, a significant quality indicator for state and national trends.

The Chief of the Medical Staff, Dr. Adams, queried the EHR database for a report on all patients who had sepsis that died in 2017. She has come to you, the EHR Operations Manager to discuss the finding as she feels the report is not giving her the information she needs. Below is a sample of the criteria she used to run the report. Evaluate it for accuracy and thoroughness and recommend changes, if necessary, and justify (explain & elaborate) your changes.  

Dr. Adam’s query:

Patient medical record number	all
Patient name	all
Discharge date	01/01/2017-12/13/2017
Discharge disposition	X = expired
MS-DRG	870, 871 872

Instructions:

1.     Identify the difference between community-acquired and nosocomial infections.

2.     Determine the ICD-10-CM codes for sepsis

3.     Explain an “MS-DRG” & how it is determined

4.     What is the goal of the study?

5.     List two objectives for the study.

6.     What additional criteria is needed for this report?

7.     Are the current criteria accurate?

8.     Identify at least five (5) additional criteria for this study

Answer 1

1 Community acquired infection is the infection acquired in the community rather than in a health care facility.

Nosocomial infection-Health care infection is an infection occuring in a patient in a hospital or health care setting in whom the infection was not present or incubating at the time of admission or the remainder of an infection acquired during a previous admission. Eg Methicillin -Resistant Staphylococcus Aureus is a type of staphylococcus bacteria that is resistant to certain antibiotics and maybe acquired during hospitalization.

2 Sepsis- A 41.9 is the ICD- 10 CM code for sepsis unspecified organism.

3 Medicare Severity Diagnosis is defined by a particular set of patient attributes which include principal diagnosis,specific secondary diagnosis,procedures,sex and discharge status.Accurate and complete ICD-9-CM coding by HIM professionals is essential for correct MS-DRG assignment and subsequent reimbursement.DRGs are assigned by a grouper program which gathers claim information based on ICD diagnosis,procedures,age,sex,discharge status and the presence of complications or comorbidities.All these factors are used to determine the appropriate DRG on a case by case basis.

4 The goal of the study is to determine the reasons of increasing nosocomial infections and related mortality.