Section R

The Society of Thoracic Surgeons Frequently Asked Questions: Adult Cardiac Surgery Database Version 2.52.1 August, 2006 How to use the interactive FAQ Document: 1. To review all clinical questions in an individual section, click on the section title below.
Section A: seq# 40-80				Section F: seq# 750-870		Section K: seq# 1630-1880			Section P: seq# 2710-3010
Section B: seq# 100-210				Section G: seq# 890-1040		Section L: seq# 1920-2350			Section Q: seq# 3020-3080
Section C: seq# 220-340				Section H: seq# 1050-1200		Section M: seq# 2360-2560			Section R: seq# 3090-3210
Section D: seq# 350-550				Section I: seq# 1210-1500		Section N: seq# 2570-2600			Section S: seq# 3220-3240
Section E: seq# 560-670				Section J: seq# 1520-1620		Section O: seq# 2610-2700
2. To review an individual Seq# clinical question, click on the Seq# title below. 310 ICUInHrs 2470 OCarAFib 340 TotHrICU 2560 OCarOthr 440 RenFail 2710 Complics 490 InfEndo 2750 COpReOth 850 ArrhyTyp 2780 CISternDeep 1050 NumDisV 2830 CNStrokP 1260 EmergRsn 2950 COtCoag 1280 OpCAB 3090-3180 Section R. 1310 OpOCard 3220 Readm30 1380 PerfusTm 3240 ReadmPro 1410 XClampTm 1640 OpMitral 1650 OpTricus 3. CC/TM: Corrections/Clarifications to Training Manual
NEW	Date	SeqNo	FieldName		Definition
	4/05		Seq# 3090 - 3180, Discharge Medication Fields		The intent of the discharge medication fields are to determine if a patient was discharged home on a medication or not. If your patient was discharged home on the medication, code as "yes", if the patient was not discharged home on a medication, for any reason, code as "no." The fields were not designed to capture non-applicable as an option. Even though the surgeon may have addressed why the patient was not discharged home on a medication does not change the fact that the patient was not discharged home on the medication. At this time, the STS is not interested in why the patient did or did not receive a medication. Of course, site may be interested in this information and are encouraged to create custom fields to capture this data.
	4/05				The intent of the discharge medication fields is to capture medications that are ordered for the patient to start or to continue taking immediately after discharge. Medications ordered at discharge without exceptions, should be captured as discharge meds. Medications ordered with exceptions, (when cleared by urology, two weeks after discharge) should not be captured as discharge meds.
*NEW!*	08/06				Pt is transferred to nursing home or LTAC and information related to discharge meds is not documented anywhere in the hard chart. I know the process for the nurse is to fax the current MARS to the transferring facility and these meds will be continued; however, this is not documented in the record. Can I abstract medications given on the last day of hospitalization as the discharge medications or do I abstract all discharge meds as "no"?			Use the MAR as discharge medications list.
		3090	ADP Inhibitors Discharge		Indicate whether or not the patient was discharged from facility on ADP Inhibitors.
	11/04				ADP stands for Adenosine Diphosphate. See Training Manual for additional information on ADP Inhibitors. The following drugs should be* captured as ADP Inhibitors:* Plavix or Clorpidogrel Ticlid or Ticlodipine Pletal or Cilostazol The following drugs should not* be captured as ADP Inhibitors:* Persantine or Dipyridimole Aggrenox (aspirin + extended release Dipyridimole)
		3100	Antiarrhythmics Discharge		Indicate whether or not the patient was discharged from facility on Antiarrhythmics.
	7/04				If a patient is discharged on Sotalol/Betapace, do we code this as an antiarrhythmic and/or a beta blocker? Sotalol/Betapace is identified as both an antiarrhythmic and a beta blocker in the Training Manual.			Sotalol (Betapace) is a Beta-Adrenergic Blocking agent and is very (most commonly) often used as an antiarrhythmic agent. Betapace is different than Betapace AF (difference is dose and safety related) and they should not be used interchangeable. It is correct to identify Sotalol (Betapace) as a Beta Blocker and/or antiarrhythmic. BUT, again, I would say the majority of the time it is used as an antiarrhythmic. Data Managers will need to abstract from the chart the reason for which the Sotalol (Betapace) was given and code appropriately: 1. antiarrhythmic or beta blocker or 2. antiarrhythmic and* beta blocker* If it can be abstracted from the patient record that the patient was placed on Sotolol for both antiarrhymic and beta blockade purposes, then both antiarrhythmic and beta blocker fields should be coded as yes.
		3110	Antiarrhythmics Discharge Medications Name		Indicate the name of the Antiarrhythmic medication the patient was on when discharged from the facility.
CC/TM	11/04				For seq# 3110, Antiarrhythmics Discharge: In the Training Manual, please remove CardizemCD/Diltiazem from the list of Antiarrhythmics. Cardizem is a Calcium Channel Blocker. No matter what the reason for placing the patient on Cardizem (to decrease atrial arrhythmia rates or to decrease spasms from radial harvest sites) do not code as an Antiarrhythmic.
		3120	DC Meds-Aspirin		Indicate whether or not the patient was discharged from facility on Aspirin or Ecotrin.
		3130	Ace-Inhibitors Discharge		Indicate whether or not the patient was discharged from facility on ACE- Inhibitors.
	3/04				~~When coding ACE (Angiotensin Converting Enzyme) Inhibitors, do not* include ARBs (Angiotensin II Receptor Blockers).~~*
	2/05				It has recently come to the attention of the STS that as of January 2005, JCAHO allows for ARBs to be captures as ACE Inhibitors. Based on this information, the STS has decided that, effective January 1, 2005, ARBs should now be captured as ACE Inhibitors. This change is only effective on and after January 1, 2005. HISTORICAL DATA SHOULD NOT BE CHANGED. 1. Prior to January 1, 2005: ARB's not to be included as ACE. 2. On or after January 1, 2005: ARB's to be included as ACE.
		3140	Beta Blockers Discharge		Indicate whether or not the patient was discharged on beta blockers.
	7/04				If a patient is discharged on Sotalol/Betapace, do we code this as an antiarrhythmic and/or a beta blocker? Sotalol/Betapace is identified as both an antiarrhythmic and a beta blocker in the Training Manual.			Sotalol (Betapace) is a Beta-Adrenergic Blocking agent and is very (most commonly) often used as an antiarrhythmic agent. Betapace is different than Betapace AF (difference is dose and safety related) and they should not be used interchangeable. It is correct to identify Sotalol (Betapace) as a Beta Blocker and/or antiarrhythmic. BUT, again, I would say the majority of the time it is used as an antiarrhythmic. Data Managers will need to abstract from the chart the reason for which the Sotalol (Betapace) was given and code appropriately, either antiarrhythmic or beta blocker.
	4/05				Some patients have a contra-indication for Beta Blockers and frequently they may be discharged without implementing this medication. On follow up it will be started in the post-op clinic or doctors office. There is no field to capture contra-indications. I talked with a hospital in my area and they stated they mark yes on discharge on all patients because they if they are not discharged on this medication it is started on follow up appointments. This is not our practice. Should these patients be marked as no?What are the plans to add a contra-indication field to this section?			Please code Seq# 3140 DCBeta=No. Regardless of the reason, the patient was not discharged on Beta blockers. The intent of the discharge meds fields is that patients MUST be discharged with instructions to begin BB at time of discharge. If they are sent home with instructions to begin at a later date or are started by some RMD after they were discharged Seq# 3140 must be coded as NO. Will consider adding Contraindicated Yes/No for the next spec upgrade.
		3150	Lipid Lowering - Dishcarge		Indicate whether or not the patient was discharged from facility on any lipid lowering medication.
		3160	Lipid Lowering Dishcarge Medication Type		Indicate the type of Lipid Lowering medication the patient was on when discharged from the facility.
	6/04				Some patients simultaneously take statins and non-statins. When coding this field does one choice take precedence over the other?			No, one does not take precedence over the other. Unfortunately, you will only be able to code either statin or non-statin. The option of choosing both will be considered in the next specification upgrade.
		3180	Coumadin - Discharge		Indicate whether the patient was discharged from the facility on Coumadin.
		3190	Discharge Location		Indicate the location to where the patient was discharged.
From version 2.41					The new field for Discharge Location lists ECF/TCC and Nursing Home among the choices. ECF and Nursing Home are used synonymously here. Can you clarify?		Following are a couple of possibilities: 1) Your institution can make the decision to code all of these patients as ECF or Nursing Home; or 2) if your institution has an ECF/TCC onsite, code the patients discharge to the onsite ECF as ECF/TCC and patients discharge to a Nursing Home or off-site ECF could be coded as Nursing Home. The Committee will be adding further clarification to this definition in the near future. (4-19-02)
From version 2.41	9/03				If a patient is discharge to a Rehabilitation Hospital, how should this be categorized, Other or Extended Care/TCU?		Extended Care/TCU.
From version 2.41	12/03				Suppose a patient is discharged to a nursing home for subacute rehabilitation (as opposed to acute nursing home care). Would this be coded as Extended Care/TCU or Nursing Home?		The rational for the move to a facility should be reflected in the type of facility selected. Therefore, maybe your area doesn't have a "rehab" facility but do have rehab capabilities within a nursing home. In this type of situation, code as an Extended Care/TCU and not a Nursing Home. Again, look at the reason for transfer to code the not straight forward transfers.
		3200	Cardiac Rehabilitation Rehab		Indicate whether, prior to discharge from the acute care facility, the patient received a referral to an outpatient cardiac rehabilitation program. Please select "Not Applicable" for those patients deemed inappropriate due to physical, mental or other limitations.
	8/04				What do we do if the cardiac rehabilitation referral is made, but the patient refuses? Should this be marked yes or no?			The intent is to capture patients that receive a referral. The intent is not to capture patients that refuse, never attended, or did not complete the program. If the referral is made, please code as "yes".
		3210	Smoking Cessation Counseling		Indicate whether, prior to discharge from the acute care facility, the patient received smoking cessation counseling. Please select "Not Applicable" for those patients with no prior history of smoking.
	4/04				Can "not applicable" be used when a patient has a history of smoking, but has not smoked in many years, or will it be thrown out if I put "yes" to smoking, but n/a to counseling?			Although there is not a parent child relationship, if patient has a history of smoking as indicated in seq# 370, then they should receive smoking cessation counseling upon discharge. For the purposes of the STS, a patient that has not smoked in ten years still requires smoking cessation counseling to be coded as "yes". If this patient did not receive smoking cessation counseling, code as "no" and not "N/A" as the patient does have a history of smoking and thus should receive the counseling. 1. + h/o smoking but did not receive smoking cessation counseling during the current hospitalization = code "no" to smoking cessation counseling 2. + h/o smoking and did receive smoking cessation counseling during the current hospitalization = code "yes" to smoking cessation counseling 3. No h/o smoking, so did not receive smoking cessation counseling during the current hospitalization = code "n/a" to smoking cessation counseling
CC/TM	3/04				The Field Clarification section of the Training Manual, for seq# 3210, Smoking Cessation Counseling, should read, Please select "Not Applicable" for those patients with no prior history of smoking.
	6/04				JCAHO guidelines require smoking cessation counseling only for those patients that have quit smoking within the last 12 months. Because of this guideline, some institutions internal reporting systems are set up to capture this information according to JCAHO. Changing their reporting systems to include capturing smoking cessation according to the STS definition is not possible. Users also state that they feel uncomfortable counseling patients that have not smoked in many years. The data specification definition, version 2.52.1, for seq# 3210 can not be changed until the next specification upgrade. All comments/suggestions received about this seq#, as well as for all seq#, will be considered for the next specification upgrade. The STS encourage all users to capture all three of the smoking fields, seq# 370, 380 and 3210 according to the definitions set forth in version 2.52.1. If it is your institutions policy not to counsel patients that stopped smoking over a year ago on smoking cessation, please code this field appropriately as no. Although the definition for smoking cessation may be changed in the future, it is important to have the data that are collected for version 2.52.1, to be reflective of the definition set forth. Some have suggested that instead of coding no to the smoking cessation field, they would just leave the field blank. The STS does not condone this practice. Please note that this seq# is not part of any risk model. It is important to understand that seq #3210 is to be reflective only of the current hospitalization. We are not interested if patients received smoking cessation counseling three years ago. Therefore, the highlighted text above has been added to the FAQ Document for seq# 3210 for additional clarification. As it is not the intent of the field, please do not review old charts attempting to determine if smoking cessation counseling was received prior to the current hospitalization.
CC/TM	12/04				The Field Intent section of the Training Manual, for seq# 3210, Smoking Cessation Counseling, should read, Identify those patients who are provided smoking cessation program opportunities PRIOR to their discharge.