Back to Basics OPC SSI and SDOM 101

Good morning and welcome to Back to the Basics, the Outpatient Procedure Component, Surgical Site Infection and Same Day Outcome Measures 101. My name is Melissa Otis and I'll be your presenter today. I'm one of the subject matter experts for the Outpatient Procedure Component. By the end of today's presentation, you will be able to navigate the NHSN application to enter SSI and SDOM events, locate tools and resources on the NHSN Outpatient Procedure Component webpage to assist with SSI and SDOM surveillance, understand how the Outpatient Procedure Component can be used in your ambulatory surgery center to improve patient safety and patient outcomes by monitoring for adverse outcomes, and finally, you'll learn what's coming soon to the Outpatient Procedure Component. Let's start with a basic introduction. Here you can see the outpatient procedure component, where it falls within the NHSN family of components. And then within the outpatient procedure component, there are same-day outcome measures, referred to as SDOM, and surgical site infections, referred to as SSI. You'll notice that healthcare personnel safety component is a separate component that includes the COVID-19 vaccine reporting, and that would not be included in today's presentation. In order to enroll within the NHSN Outpatient Procedure Component as an ASC, the third digit of your CMS certification number, or CCN, should be a C. This identifies you uniquely as an ASC. And here's an example demonstrating what that C as a third digit within your CCN would look like. OPC was modeled for the patient safety component that's used for inpatient surveillance. We worked closely with ASC industry leaders, including the ASCQC, the Ambulatory Surgical Center Quality Collaboration, as we develop the outpatient procedure component. There's not much literature regarding outcome and process measures for ASCs, and OPC was created to begin to meet the unique needs of ASCs and to add to the development, and add to and develop our understanding of the risk of adverse outcomes within the outpatient environment. OPC may help facilities meet infection control requirements, including some state-based requirements. You will wanna check with your state HIA coordinator to ensure that all reporting guidelines are met. Are ASCs required to report? This is a question we get frequently. NHSN does not mandate reporting. NHSN is simply a mechanism for collecting and analyzing surveillance data based on what your facility chooses to enter. The decision to use the NHSN outpatient procedure component depends on your facility internal risk assessment and requirements of reporting by your state or other organizations. Let's jump into the monthly reporting plan. The monthly reporting plan informs NHSN which outpatient procedure modules you will be using during a given month. If a module is included within your monthly reporting plan, this is an agreement to follow the details of the module in its entirety. In-plan modules are included within the monthly reporting plan. The NHSN surveillance protocols will be used in their entirety, and data is included within NHSN annual reports or other NHSN publications. Off-plan modules are not included in the monthly reporting plan. The NHSN surveillance protocol is not required to be used in its entirety, and data is not included in NHSN annual reports or other NHSN publications. In order to add a monthly reporting plan, step one is you'll select reporting plan from your NHSN home left navigation bar, and then select add from the pop-up that appears. In order to enter a monthly reporting plan, you will simply enter the month and the year for which you will want to enter the monthly reporting plan. If for that particular month, you are not following any NHSN outpatient reporting that particular month, you will select the checkbox that I've indicated with the orange arrow. If you are including the same day outcome measures in your reporting, you will select the checkbox that's marked with the X on step four. And next, you will select the surgical site infection surveillance that you'll be performing for your facility. You'll simply select the drop-down box to select the appropriate operative procedure categories for which you will be performing surveillance. If you will be performing the same surveillance as you did from the previous month, you'll notice there is a copy from previous month button that you can simply copy that forward from the last month. Finally, you'll select save. Let's talk about adding a same-day outcome measure. Before we jump into that, let's talk about what a same-day outcome measure is. All inpatient encounters are included when you select to do same-day outcome measure surveillance. You will monitor all patient encounters for the following events, patient burn, patient fall, wrong site, side, patient, procedure, or implant, and transfer or admission to a hospital upon discharge from the ASC. Same-day outcome measures can be reported for any procedure, including any non-NHSN operative procedures. Let's look at a few examples. First, let's start with a patient burn. Mr. Klein is admitted to eye care ASC and has a cataract procedure performed. During the procedure, the phaco needle becomes clogged, causing thermal damage or a burn to the cornea. The surgery was still able to be completed and a suture was placed on the burn wound. This would be reported as an unintended injury caused by exposure during a cataract procedure or a burn and would be reported within your same-day outcome measure criteria. Next let's look at a patient fall. A fall is described as a sudden, uncontrolled, or unintentional downward displacement of the body to the ground or other object, excluding falls resulting from violent blows or other purposeful actions. An example would include Miss Sinclair. She's admitted to Metro ASC and has a capro or knee prosthesis performed. After the procedure, she was being transferred to a wheelchair and became lightheaded and dizzy. She fell to the floor. She did not lose consciousness and no injuries were identified. Later that day, Miss Sinclair was discharged home. This would be reported within the same day outcome measures as a patient fall. Next is a wrong event. This would be described as the wrong site, side, patient, procedure, or implant. An example would include Mr. Levine. He was admitted to downtown ASC for a right knee prosthesis or a KPro due to severe osteoarthritis. The patient signed the informed consent for the right knee prosthesis. And upon wakening from anesthesia, the patient notes severe left knee pain and discovered that the KPro was performed to the left knee. This would be a wrong side event and would be reported as such within the SDOM. Finally, we have all cause hospital transfer or admission. This would be any transfer or admission from the ASC directly to an acute care hospital, including the hospital emergency room. And this would be regardless of the cause of the transfer or admission. An example includes Mrs. Waldron. She was admitted to small town ASC for a right foot amputation or an amp procedure. The procedure was performed without incident. Approximately eight hours after the procedure, she began having severe left-sided chest pain that radiated down the left arm and she began having nausea and shortness of breath. The patient was transferred by ambulance to small town hospital ED to determine if she was having a myocardial infarction. This would be reported within your SDOM as an all cause hospital transfer or admission. Please note, for each patient that experienced an SDOM event during an ASC encounter, you will complete an event form. If the patient experiences more than one event of a different measure during the same encounter, all events should be recorded on the same event form. Example would include a patient experiences a fall and a burn during the same encounter, both a fall and a burn would be recorded. If a patient experiences more than one event of the same measure during the same encounter period, you will simply report that the patient has multiple wrong side procedures or multiple falls. If no events occur during an encounter, you will be completing that there were no events for that particular period. Please note, SDOM surveillance is concurrent, meaning that it's initiated while the patient is under the care of the organization and surveillance will end at discharge. In order to add an SDOM event, within the left menu on the NHSN homepage, you will click event and select add. All mandatory fields are noted in this screen with a red asterisk. You'll notice your facility name will populate automatically within the facility ID field. The patient ID is your unique identifier within your facility for your patient. You will also see your patient ID, the gender, and the date of birth. Next, you'll select under the event type field, same day outcome measure or OPSDOM. Then you'll select the type of outcome measure that you have to report as well as the date of event. Finally, you'll select save. Now that we've covered SDOM reporting, let's talk about surgical site infections. As a reminder, an SSI is an infection. It could be superficial, deep, or organ space that develops during the surveillance period following an NHSN operative procedure. First, let's define what an NHSN operative procedure is. It's an operative procedure that is included within the CPT, or current procedural terminology code mapping, and has at least one incision, including laparoscopic approach, and takes place in an operating room or other room meeting OR standards. Surgical site infection reporting specifications. Outpatient procedure component SSI criteria is similar to that used in the patient safety component. The variables are similar, but there are fewer reporting fields. It enables SSI reporting for all types of SSIs, including potential state-based mandatory requirements. You will want to check with your state HII coordinator to ensure that all state-based requirements are met. The next series of slides will show the differences between the patient safety component and the outpatient procedure component for those of you that are familiar with the patient safety component. If you are not already familiar with the patient safety component, please disregard this information. As you can see in this first slide, trauma and emergency are not reported within the outpatient procedure component. Additionally, the closer technique and the fields for fusion, H-Pro and K-Pro are not completed during this outpatient procedure component. In addition, Chapter 17 site-specific reporting instructions or definitions are not included within the outpatient procedure component. And PATOS or present at the time of surgery is not a designation within the outpatient procedure component. There are 30 operative procedures included within the outpatient procedure component for monitoring as opposed to the 39 for the patient safety component. These are the categories that are not included or not available for use within the outpatient procedure component. AAA or abdominal aortic aneurysm repair, cardiac surgery or CARD, coronary artery bypass grafts or CBGB, chest and donor sites or CBGC, chest only, craniotomy or crane, cesarean section or C-section, heart transplant or HTP, kidney transplant or KTP, and liver transplant or LTP. Within the outpatient procedure component, we have general SSI criteria that's used for all operative procedure categories, with the exception of breast. breast does have its own surveillance criteria for superficial, deep, and organ space surgical site infections. Why do we have a separate SSI criteria for breast surgery? Breast procedures are identified as the highest volume and highest SSI risk among ASCs reporting to NHSN. Measure specifications developed by CDC and NHSN along with the ASCEQC, and it was measure field tested by the Colorado Department of Public Health and Environment. Remember the goal of the outpatient procedure component is to address the unique care environment of the ASC. There are 30 NHSN operative procedure categories included within the outpatient procedure component, and the surveillance period is either 30 days, as highlighted here with orange, or 90 days, as you can see, highlighted in orange at the bottom of the screen. Keep in mind that there are a number of operative procedures that are performed in ASCs that are not included in one of the ASC or NHSN operative procedure categories, such as endoscopic procedures, ophthalmic procedures, and as a reminder, these are not included within the outpatient procedure component. An ASC may choose to monitor any or all of the 30 NHSN operative procedure categories performed within its facilities and those specified for mandates or other reporting requirements. The numerator would include the SSI for the selected procedure category and the denominator is a total number of procedures for the selected procedure category. In order to add your SSI event, first you must enter the denominator or procedure reporting. In order to add an SSI event, as I mentioned, you will have to first have this data entered. This procedure or denominator reporting can be entered either manually, as you can see here in the screenshot provided. This will provide for you everything marked with a red asterisk is required to be reported in your denominator data for outpatient procedure component. Or you can choose to enter this via comma separated values file or CSV. We do have detailed instructions on the outpatient procedure component webpage on how to upload using a CSV file, including a template for your use. Surgical site infections are identified as either superficial, deep, or organ space. As you can see, the superficial incisional SSI includes the skin and subcutaneous tissue. Deep incisional SSI generally includes the fascia or the muscle, and organ space is below the fascia or the muscle. In order to add an SSI event, you'll select Event and Add from the left menu. You'll enter all mandatory fields. You'll notice they are the same required fields that we discussed before. Your facility ID will automatically populate, and then you will enter your unique patient ID, patient's gender, and date of birth. You may choose to enter any of the additional information that's provided, but note these are not required fields. Next, you'll select from the event type, OPSSI, surgical site infection. Next, you'll want to link the procedure to the event. So you'll click the link slash unlink procedure button, and it will pull up the procedures for this particular patient. You'll select the appropriate operative procedure that you are reporting an event for. It will automatically populate then for you the procedure code and the CPT code, as well as the procedure date. Next, you'll enter the date of the encounter, the SSI level. Remember, your choices are superficial incisional, deep incisional, or organ space. And then you'll select all the specific criteria used to meet that particular definition. In this example, we've selected an organ space SSI, and it was detected via gross anatomic exam or an abscess was noted. In addition, you'll notice you'll need to enter how the SSI event was detected. Was it detected via active or passive surveillance? And if it was active surveillance, you'll select the type of active surveillance. Did the patient die? And were any pathogens identified? Finally, you'll select save. Now that we've discussed entering an event for SDOM as well as SSI, let's talk about the outpatient procedure component website and a little bit about the navigation of this website. Here you see we have the landing page for ambulatory surgery centers. Within the landing page, we have a link where you can select ambulatory surgery centers. Once you select that link, you will see all available modules for your ASC, including SSI and SDOM. As previously mentioned, you will also have access to the Healthcare Personnel Safety Component, or HCP. Please note, this includes COVID-19 vaccine reporting, but is not included during the training today. Next, you'll see the landing page for surgical site infections. We have a variety of resources available, including code mapping, supporting chapters, and other key term information. Next, we have the landing page for same-day outcome measures. And you can find a variety of resources here, again, including the protocol, supporting chapters, and on the right side, you can see there is a training and educational roadmap. We do have a variety of analysis resources. Please note today's presentation will not cover the analysis portion of the outpatient procedure component that is covered in a separate training by my colleague, Irene Kahn. I recommend that you take a look at that presentation as it will be very helpful from an analysis standpoint. And as I mentioned, we do have a variety of training resources available, including training videos, self-paced trainings, and other resources. I highly encourage you to take a look at the training components within the outpatient procedure component, as they will be very helpful as you begin use of the outpatient procedure component. Let's talk about some benefits of using the outpatient procedure component. Some of the benefits of using the outpatient procedure component is that the module includes measures that have been vetted by external ASC quality organizations and as data are collected, it will allow for national benchmarks to be established, including for those for all payer types. The use of the NHSN is advantageous to facilities and public health entities because CDC is able to aggregate and analyze the data and provide reports at the facility, state, regional, and national levels to monitor quality, process, and outcome measures. As I noted at the beginning of this presentation, we will be talking quickly about what's coming soon to OPC. We're very excited to roll out the new user toolkit. If you found today's presentation helpful, you will find the new user toolkit extremely helpful. It is full of useful guides, tips, and tricks to help the new OPC users complete some of the following tasks, including logging in, completing an annual survey, adding or editing a monthly reporting plan, how to perform SSI and SDOM surveillance, entering SSI and SDOM events, entering denominator data, how to address alerts, creating custom options, and analysis of SSI and SDOM data. And trust me, there will be much more as well. The next coming soon to outpatient procedure component is a knee prosthesis or a KPRO measure. This measure will be similar to the breast measure in that it's specific just for those patients who have had a knee prosthesis and it will provide surveillance definitions following a qualifying KPRO procedure. The rollout of this measure will be within 2023. This concludes today's training. For any questions or additional concerns, please contact the NHSN help desk at NHSN at CDC.gov. Thank you for your time today, and I appreciate your attention.