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Hospital Circular 15/1998

Date Issued: August 26 1998
Publication: 15/1998
Distribution:

  1. Public Hospitals
  2. Private Hospitals

Subjects: Reporting Admitted Patient Episodes to the Victorian Inpatient Minimum Database (VIMD)

Table of Contents

Background
Definitions
Criteria for Admission
Criteria for Admission - Reporting to the VIMD
Criteria for Admission - Values
Criteria for Admission - Guide for Use
Leave
Other related VIMD definitions and data items

Background

This document replaces circular 19/1993 - providing administrative guidelines for complying with hospital admission policy in Victoria. Admission policy in Victoria encompasses concepts contained in the 1993 Medicare Agreement, the National Health Data Dictionary (NHDD) Version 7.0, the Commonwealth Same Day Procedure Manual, August 1996 (as updated), and the PRS/2 Manual, Version 8.

Admission policy issues are currently being considered by a combined Casemix Information Development Exchange (CIDEX) and Australian Clinical Casemix Committee (ACCC) Working Group which will report its finding to the National Health Data Committee (NHDC). In addition, the funding and reporting of same day admitted services is being reviewed by the Department of Human Services. Any changes to admission policy that arise from the work of these groups and/or the negotiations of the new Australian Health Care Agreement, may result in amendments or the release of a new circular.

The decision to admit a patient (rather than to treat them as an outpatient or accident and emergency patient) should be made by a medical practitioner and cannot be delegated to administrative staff or automated. Thus Resident and Senior Medical Staff, Nursing Staff and personnel involved in the admission procedure within hospitals, including staff of the Admission Office, Medical Records Department and Hospital Information Systems Department, need to be fully acquainted with the content of this document.

Definitions

An admission is the administrative process which signifies the commencement of an admitted patient episode of care. An admission may be formal or statistical.

Formal admission:

The administrative process by which a hospital records the commencement of treatment and/or care and accommodation of an admitted patient.

Statistical admission on care type change:

The administrative process by which a hospital records the start of any episode of care, subsequent to the initial episode of care (which commences with a formal admission), within a single hospital stay.

Refer to Section B of the PRS/2 Manual for details of the Care Types reported to the VIMD.

The mandatory VIMD data item Admission Source records whether the admission is statistical or formal. Refer to Section B of the PRS/2 Manual for more information.

An admitted patient is a person who has been assessed by the treating clinician as meeting at least one of the minimum criteria for admission and who undergoes the hospital's formal or statistical admission process as either a same-day, overnight or multi-day stay patient.

The criteria for admission are stated, then explained in the following sections.

Criteria for Admission

The minimum criteria for admission were initially drawn from the 1993 Medicare Agreement, which in turn were based upon criteria for the admission of private patients for day only procedures, most recently detailed in the Commonwealth publication Same Day Procedure Manual, August 1996. Since then they have been adapted to incorporate the admission of all newborns, in accordance with the NHDD V7.0. In the minimum criteria for admission stated below, the reference to 'Same Day Procedures Manual' means the updated version contained on the Internet (http://www.health.gov.au/pubs/circfinl/spcintst.htm).

Before a patient can be admitted, at least one of the following criteria, must be met:

or

or

or

Criteria for Admission - Reporting to the VIMD

Criterion for Admission must be reported at admission for all admitted patients. If the care intended to be provided to a patient does not meet any of the criteria for admission, then the patient should not be admitted and the episode not reported to the VIMD. Hospitals are responsible for ensuring that appropriate procedures and records are maintained to facilitate accurate reporting and to justify the admission. The list of criteria for admission on the previous page is complete - there are no other criteria for admission. For example:

The specific criteria under which each patient is admitted does not impact upon casemix funding.

Change To Planned Treatment

Where a patient's condition requires a different course than that planned at admission, the hospital must retain on the VIMD the original Criterion for Admission. For example, a newborn who changes Qualification Status must retain their original Criterion for Admission code (N or U).

Cancelled Treatment

There will be occasions where a patient, who is admitted, subsequently has their planned treatment cancelled and is separated on the same day:

The level of same-day admissions involving cancelled procedures will be continually monitored.

Admission from Emergency Department

When a patient is admitted from the Emergency Department then the admission time is the time treatment commenced in the Emergency Department. That is, when the patient is first treated by a nurse or doctor, whichever comes first. The Emergency Department occasion of service is counted in these circumstances.

'Parentcraft'

'Parentcraft' describes the type of care provided by Early Parenting Centres though similar care may be provided by other hospitals. In regard to 'parentcraft' care and treatment, only those family members who satisfy the minimum criteria should be admitted. Whilst mother, father, baby and siblings may attend the hospital, normally only one member of the family should be admitted. In some instances, admission of two or more family members may be justified where they are affected by separate problems; or where problems affect more than one member, such as breastfeeding difficulties, where care and treatment are required for both mother and baby.

Criteria for Admission - Values

For the purposes of reporting Criteria for Admission to the VIMD, select the first appropriate category:

B = Day Only Bands 1A, 1B, 2, 3 and 4

C = Type C Professional Attention Procedures with Certification

N = Qualified newborn

U = Unqualified newborn

O = Patient expected to require hospitalisation for minimum of one night

For example, if the patient is admitted for a Day Only Band 1A procedure, but, because there will be no one at home to care for the patient that night, the management plan at admission is that the patient will remain overnight, the Criterion for Admission code selected should be B.

Criteria for Admission - Guide for Use

B - Day Only Bands 1A, 1B, 2, 3 and 4

It is expected that the majority of Type B procedures will (and should) occur in an admitted patient setting and be reported to the VIMD accordingly. For example, it has consistently been agreed that patients should always be admitted for each episode involving renal dialysis.

Code B is the correct code for patients who meet Criterion B but stay in hospital overnight, whether that overnight stay was planned or unplanned at the time of admission.

For the purpose of VIMD reporting, there is no significance in, nor requirement to, separately identify the various bands. They are included in the definition to highlight the consistency with the classification of private patients by hospitals for health insurance claim purposes.

When a private patient is admitted for a Type B intervention but stays overnight, the relevant section of the 'Private Patient Hospital Claim Form' must be completed. As advised in Circular 6/1998, the Commonwealth are phasing out the use of form 1830 which was formerly used for certification purposes.

C - Type C Professional Attention Procedures with Certification

Type C Exclusion List

The exclusion list of procedures (the 'Type C Exclusion List') identifies services which are not normally accepted as same day admissions and would usually be undertaken on a non-admitted basis (outpatient, accident and emergency). However, they can be admitted if this is justified by the patient's medical condition or other special circumstances. This list overrides the general criteria listed under the definition of the bands.

The Commonwealth Department of Health and Family Services regularly updates the Type C Exclusion List which appears in the Same Day Procedure Manual. Circulars containing these updates are distributed to hospitals and they can also be accessed on the following internet address: http://www.health.gov.au/pubs/circfinl/spcintst.htm

Code C is the correct code for patients who meet Criterion C but stay in hospital overnight, whether that stay was planned or unplanned at the time of admission.

Extended Medical Treatment - Emergency, and Non-Emergency

It is acknowledged that the non-surgical component of day admissions is not well addressed in the Same Day Procedures Manual. In order to establish some consistency in data collection between hospitals, the decision to admit should be based on:

Certification

Whilst the Type C Exclusion List identifies services which will not normally be accepted as same day admissions, there will be occasions when patient admission for the provision of Type C services is warranted on the grounds of the medical condition or other special circumstances that relate to the patient. These details must be documented.

For privately insured patients:

The attending medical practitioner should complete the relevant section of the 'Private Patient Hospital Claim Form'. As advised in Circular 6/1998, the Commonwealth are phasing out the use of form 1830 which was formerly used for certification purposes.

For patients other than privately insured patients:

The Department no longer requires completion of a pro-forma. However, documented justification for the admission for Type C procedures must be included in the medical record. Audits of medical records will be conducted for the purpose of ensuring that Type C services provided in an admitted patient setting are warranted.

N - Qualified newborn

Code N should be recorded if the newborn is qualified at the time of admission. While the Qualification Status may subsequently change to unqualified, the Criterion for Admission and the Care Type should not be changed.

U - Unqualified newborn

Code U should be recorded if the newborn is unqualified at the time of admission. If the Qualification Status subsequently changes to qualified, the original Care Type should be changed, but the Criterion for Admission should remain as originally recorded.

O - The patient, following a clinical decision, is expected to require overnight or multi-day hospitalisation

This category involves the admission of patients with the expectation, at the time of admission, that the patient requires overnight or multi-day hospitalisation (this hospitalisation may be provided by a subsequent hospital to which the patient is transferred).

This category is therefore intended to cover the critically ill patient who presents to the emergency department but dies within a few hours despite intensive resuscitative treatment and the patient who needs resource intensive emergency stabilisation for a short period, prior to transfer to another hospital.

Thus criterion Code O is not altered if the patient dies, is transferred or is discharged on the same day. The decision to admit to this category must be made on the basis of clinical appropriateness, and it is not intended that such a decision be determined simply by the duration of the stay.

Leave

A sound understanding of the underlying concepts is essential for accurate reporting of episodes for patients who leave hospital during an episode of care. There are two types of leave - contract and normal.

Contract Leave

Contract leave is a period spent as an admitted patient at a contracted (service provider) hospital, during an episode where the patient is also admitted to the contracting (purchasing) hospital. Contract leave days are reported only by the contracting (purchasing) hospital, and are treated as patient days and included in the length of stay at that hospital. There is no limit to the duration of contract leave. Periods of contract leave are not counted as separations.

Normal Leave

Normal leave occurs when an overnight or multi-day patient leaves the hospital temporarily with the approval of the hospital and/or treating medical practitioner, with the intention that the patient will return within seven days to continue the current treatment. No patient day charges are raised, nor patient days counted, while the patient is on normal leave. Periods of normal leave are not counted as separations.

If the absence is planned to be greater than seven days or if the patient fails to return within seven days:

Where it is intended that a patient return to the hospital within seven days for a related but different procedure (e.g. a coronary angiogram is to be followed by heart surgery) the patient should be separated and re-admitted.

Where it is intended that a patient return to the hospital within seven days for a regular Type B procedure (dialysis, chemotherapy, plasmapheresis, etc.) the patient should be separated and re-admitted.

However where it is intended that a patient return to the hospital at regular intervals of not more than seven days for a series of non-Type B procedures, the patient is:

In such cases documented justification for the admission must be provided.

Other related VIMD definitions and data items

Refer to Section A and B of the PRS/2 Manual for information on related definitions and data items. These include:

Please contact the PRS/2 Help Desk on 9616 8141 or by email:
PRS2.Help-Desk@dhs.vic.gov.au, if you have any queries.

CHRIS BROOK
DIRECTOR
ACUTE HEALTH

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