Case #672

C671 Deceased during daycare visit

Added by Ralph Dahlgren 29 days ago.

Status:ActiveStart date:2020-01-30
Priority:MinorSpent time:-
Assignee:-
Category:-
Target version:-
Initiator:Sweden Target year:2021
Case type:Major Owner / responsible:National organisations
MDC:GEN Old forum status:
Target Grouper:SWE

Description

2020-01-30 Ralph Dahlgren
Problem
Deceased during daycare visits are now grouped to in care DRGs. These patients in Sweden will mostly be from the emergency wards.
When out patients are at daycare visits and dies during the visit there are a problem how to track these patients in PAR (Swedish patient register) and KPP (Cost Data register). They cannot be found actually.

When some patients arrive at the Emergency Ward they are already dead at arrival but is still admitted to the Emergency Ward, other dies in the Emergency Ward even after treatment.
These patients are handled the same in our administration system no-matter where death occurs. They will be handled like in patients. The Swedish administration system do not allow a patient to be signed out as dead at the moment due to the rules in the Swedish DRG-system.
The reason for handling these patients in different ways is multifactorial. Partly because it looks different at our Emergency Wards. It is different for big city hospitals compared to small rural hospitals. Added to that in certain situations, one ‘must make', from an ethical perspective, different decisions.

As far as I understand it was decided, this was before I started to work with DRG, that the patient that dies during an out patient visit was as resource consuming as an in-patient. This might be true in some cases but it might also not be true in others.
As it is now in Sweden we cannot even begin to investigate these patients.
Analysis
Swedish Department of Health and Welfare 2020-01-28
Sweden cannot get any secure data from either the Swedish Patient register (PAR) or our Cost data base (KPP) concerning the amount of patients involved or the resources that is used.
It is actually also an administrative problem at the moment.
In Sweden there are different ways of handling these patients in different counties, even within different counties. I mostly involves the Emergency ward and is managed differently in different Regions / County councils in Sweden the DRG system must be adapted to the reality we have.
So this is a problem that should be solved.
In the Swedish DRG system, if a daycare patient is discharged as deceased after a visit the patient is grouped into a DRG for in care patient.
In our data bases we can get the numbers involved, to divide in complication levels are not possible. The numbers that we can find right now to low. We think that will be possible in the future with the new DRG.

Suggestion
Swedish Department of Health and Welfare 2020-01-28
Sweden wants to create a new DRG for out patients who dies during a daycare visit.
The DRG should be located high up in the hierarchy.
If located high up in the Swedish DRGlogic all patient that dies during the daycare visit will be grouped to this DRG.
For the time being we want everyone of these patients to be grouped to one DRG when they are discharged as Deceased.
This also means that the very few patients that dies during day-surgery also will be grouped to this new DRG if not major procedures are done, they are excluded.
Mostly the cases will be at the emergency wards. In Sweden this is where the patients mostly are pronounced dead at outpatient situations.
For Technical changes see ‘Technical changes C761 Deceased during daycare visit.xlsx
Decided changes
Swedish Department of Health and Welfare 2020-01-28.
Sweden has made three rows for the Swedish DRGlogic to make sure that all the patients outpatients that dies during a visit will be grouped to this new DRG (When not having OR 1 procedures done).
Sweden will implement this new DRG from 2021.

DRG change
All out-patients that dies during a daycare (except those with OR 1) will be grouped to this new DRG X09O Deceased during open daycare visit, specialized care visit. It will effect some in care DRGs which we cannot foresee right now. Resources that will be allocated cannot be found right now.

Technical change
Sweden will create three new rows in our DRGlogic table. These three rows will lead to the same DRG.
Four Swedish procedure codes: GD006 (WXYB00) Konstaterande av dödsfall (i), XV011 (ZYZX94) Visning av avliden (i), XV013 (WXYX90) Vård av avliden inför eventuell organdonation, QX007 (WXYX90) Omhändertagande av avliden (i) will get a new PROCPR 40V60 Deceased during daycare visit.
Nine Swedish procedures codes: DF010 (FXXA00) Elkonvertering, defibrillering UNS (i), DF012 (WAA902) Toraxkompression, DF017 (FXXA05) Mekanisk toraxkompression (ej manuell), DF025 (WAA902 ) Elkonvertering, defibrillering av kammararytmi, DF026 (WAA902) Elkonvertering, defibrillering av förmaksflimmer, planerat, DF027 (WAA902) Elkonvertering, defibrillering av förmaksflimmer, akut, DF028 () Hjärtlungräddning (i), DG017 (WAA900) Trakeal intubation, DG018 (WAA704) Trakeal intubation, fiberendoskopisk will get a new PROCPR 40V62 Intervention for deceased during daycare visit.
Two new proc pro 40V60 and 40V62
The rows will look like below:
ID drg english rtc icd or procpro1 secproc1 disch dur
000D0000007 X09O Avlidna u öppenvårdsbesök O 0 + 40V60 40V62 <1
000D0000008 X09O Avlidna u öppenvårdsbesök O 0 + 40V60 <1
000D0000009 X09O Avlidna u öppenvårdsbesök O 0 N E <1
The last row has OR N and disch E, this to include all daycare out-patients but not those with major surgery.
See the file: ‘Technical changes C761 Deceased during daycare visit.xlsx’

Technical changes C761 Deceased during daycare visit.xlsx (18 KB) Ralph Dahlgren, 2020-01-30 13:45

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