Hospital Complications

Question: How should complication date be recorded for multiple complications? Do you need to "Save and New" for each complication?

Answer: Yes, if the complications occur on different dates, you create a new complication form for each date.

Question: How are facilities showing (in the registry) that the manager/burn coordinator is verifying that the complication met definition?

Answer: This is not required in the registry but should be done by the registrar entering the data with the appropriate personnel from their burn center.

Question: Every patient that goes on Continuous Renal Replacement Therapy (CRRT) should also have AKI (Acute Kidney Injury) stage three input as a hospital complication, correct?

Answer: These two data points are not tied to each other and there may be times when it is felt necessary to be on CRRT but the patient does not have AKI stage 3.

Question: Looking at the most recent version of the ABA Data Dictionary, listed under the section "Complications", graft or flap loss is defined as "…requiring a return to the OR for repair." No further details or supplemental information is provided that specifies a percentage nor specifics outlining body areas affected.

Answer: The Data Dictionary definition for graft loss specifically doesn't mention percent of graft take as this is very difficult to define or compare between centers. The Data Definitions Workgroup and QBR Committee determined that the important complication to define is wounds that were grafted that require a return to the O.R. for a regraft to definitively close the wound. Centers may decide they would like to also look at percent graft take for the grafts as a whole or individual grafts, whether or not they require regrafting, but this is not done in the registry.

Question: Should the seizure complication be assigned if a patient, who has previously been diagnosed with seizures prior to their injury, has another seizure in the hospital?

Answer: Yes, if the patient has a seizure in the hospital, the seizure should be included in the Complications field. If they have a pre-existing history of seizures, you should also check this box in the Co-morbid Conditions of Epilepsy/Seizures.

Question: If a patient comes back through the clinic with graft loss and wound infection, and the patient was re-admitted and had a repeat procedure, should it be captured as graft loss, given it developed outpatient?

Answer: It would depend on when the graft loss occurred. If the dressing on the graft had been taken down and the graft had a good take and no wound infection in the hospital, and then the graft loss occurred at some point post-discharge, it would not be recorded as a hospital complication of a graft loss requiring regraft. The graft loss occurred as a result of some event occurring after the initial graft take had been noted to be good and the patient was discharged.

If the patient was discharged with the post-operative dressing still intact and comes back to the clinic for dressing removal, it is noted that the patient has significant graft loss that requires a regraft, that should be noted as a complication in the admission that the graft was first placed. The reason for this is it is not possible to determine whether the graft loss occurred as a result of a complication with the initial graft procedure or a post-discharge event, so the prudent response is to consider it a complication of the procedure. . It should be captured as a graft loss requiring an unplanned readmission, regrafting and an unplanned return to the Operating Room.

Question: If a patient comes back through the clinic with graft loss and wound infection, and is re-admitted for a repeat procedure, should this be captured as a graft loss, given that it developed as an outpatient?

Answer: If the dressing on the graft had been taken down and the graft had a good take and was considered healed and with and no wound infection in the hospital, and then the graft loss occurred at some point post-discharge, it would not be recorded as a[AR1]  hospital complication of a graft loss requiring regraft. The graft loss and infection cannot be determined if it was caused by the hospital.

If the patient was discharged with the post-operative dressing still intact and comes back to the clinic for dressing removal. In that case, it is noted that the patient has significant graft loss that requires regrafting, which should be documented as a complication in the admission where the graft was first placed.[AR2]  The reason for this is that it is not possible to determine whether the graft loss occurred as a result of a complication with the initial graft procedure or a post-discharge event, so the prudent response is to consider it a complication of the procedure. It should be captured as a graft loss requiring unplanned readmission, regrafting, and an unplanned return to the Operating Room.

 [AR1]not recorded as hospital complication graft loss? do we not track reason for readmission?

 [AR2]this is confusing to me. why is this different than the example above?

Definition of Complications

Question: With use of the VAE (Ventilator Associated Events) chapter in the CDC/NHSN definitions, should VAC be reported as pneumonia as well or only IVAC and PVAP because it more aligns with PNEU chapter.

Answer: Please discuss this with your Infection Preventionist and use what they are using for pneumonia, vent related.