Emergent Care OASIS-C Contact: Cindy Skogen, RN (OEC) 651-201-3818, or health.oasis@state.mn.us for questions. Source: Center for Medicare and Medicaid Services Emergent Care

M2300 Emergent Care (M2300) Emergent Care: Since the last time OASIS data were collected, has the patient utilized a hospital emergency department (includes holding/observation)? ⃞ 0 – No [ Go to M2400 ] ⃞ 1 – Yes, used hospital emergency department WITHOUT hospital admission ⃞ 2 – Yes, used hospital emergency department WITH hospital admission ⃞ UK – Unknown [ Go to M2400  ] OAI note – For the slides that explain response options, put them in numerical order. Too confusing to jump around… Emergent Care

M2300 Emergent Care (cont.) Identifies whether the patient was seen in a hospital emergency department at or since the previous OASIS assessment Responses to this item include the entire period at or since the last time OASIS data were collected, including hospital emergency department utilization that results in a qualifying hospital admission necessitating Transfer OASIS data collection Includes holding and observation in the emergency department setting only OAI edit: typo corrected in second bullet Emphasize this is a big change from OASIS-B1, as now only visits to the ER count and item reports whether or not an ER utilization resulted in an inpatient admission. CMS Q & A – October 2010 Question 16: For M2300 is "since the last OASIS assessment" defined the same as M2400 - at the time of or since the last OASIS assessment? Answer 16: The timeframe under consideration for M2300, Emergent Care, is defined as "At or since the last time OASIS data were collected. Note: For all OASIS items that include the phrase "since the previous OASIS assessment" (M1500, M1510, M2004, M2015, M2300 and M2400), the timeframe should be considered "at or since the previous OASIS assessment". Emergent Care

M2300 Emergent Care (cont.) Excludes: Urgent care services not provided in a hospital emergency department Doctor's office visits scheduled less than 24 hours in advance Care provided by an ambulance crew without transport Care received in urgent care facilities Urgent care facilities defined as freestanding walk-in clinics (not a department of a hospital) for pts in need of immediate medical care Emergent Care

M2300 Emergent Care (cont.) Select “0-No” if a patient was directly admitted to the hospital and was not treated or evaluated in the ER And Had no other emergency department visits at or since the last OASIS assessment OAI edit: Arranged so “0” is before “1” Emergent Care

M2300 Emergent Care (cont.) Select “1” or “2” if a patient went to a hospital emergency department regardless of who directed them to go or if it was pt/CG decision “Hospital admission” is defined as admission to a hospital where the stay is for 24 hours or longer, for reasons other than diagnostic testing Emergent Care

M2300 Emergent Care (cont.) If patient went to a hospital ED, was “held” for observation, then released, the patient did receive emergent care The time period that a patient can be "held" without admission can vary OASIS Transfer is not required if the patient was never actually admitted to an inpatient facility Emergent Care

M2300 Emergent Care (cont.) Select “1 - Yes, used hospital emergency department WITHOUT hospital admission” - not “2” for a patient who: At or since the last time OASIS was collected, experienced both a direct admission to the hospital without treatment or evaluation in ER And Accessed a hospital ER that did not result in an inpatient admission OAI note: In this case, there was not an ER visit that resulted in a hospital admission, even though there were ER visits and inpatient admissions since the last time the OASIS were collected. Emergent Care

M2300 Emergent Care (cont.) Select “1 - Yes, used hospital emergency department WITHOUT hospital admission” when: A patient dies in a hospital emergency department Note a Transfer OASIS is completed Not "Death at Home” Emergent Care

M2300 Emergent Care (cont.) Select “2 - Yes, used hospital emergency department WITH hospital admission” If a patient utilized a hospital emergency department more than once, at or since the last OASIS assessment And Any ER visit, at or since the last OASIS assessment resulted in hospital admission Otherwise, select Response 1 Emergent Care

M2300 Emergent Care (cont.) Select “2” if patient went to hospital ED and was subsequently admitted to the hospital An OASIS Transfer assessment is required (assuming the patient stay was for 24 hours or more for reasons other than diagnostic testing) Emergent Care

M2310 Emergent Care Reason (M2310) Reason for Emergent Care: For what reason(s) did the patient receive emergent care (with or without hospitalization)? (Mark all that apply.) This item is used in the calculation of quality measures. Emergent Care

M2310 Emergent Care Reason (cont.) (M2310) Reason for Emergent Care: For what reason(s) did the patient receive emergent care (with or without hospitalization)? (Mark all that apply.) ⃞ 1 – Improper medication administration, medication side effects, toxicity, anaphylaxis ⃞ 2 – Injury caused by fall ⃞ 3 – Respiratory infection (e.g., pneumonia, bronchitis) ⃞ 4 – Other respiratory problem ⃞ 5 – Heart failure (e.g., fluid overload) ⃞ 6 – Cardiac dysrhythmia (irregular heartbeat) ⃞ 7 – Myocardial infarction or chest pain ⃞ 8 – Other heart disease Instructional Guidance Instructions to Class Emergent Care

M2310 Emergent Care Reason (cont.) ⃞ 9 – Stroke (CVA) or TIA ⃞ 10 – Hypo/Hyperglycemia, diabetes out of control ⃞ 11 – GI bleeding, obstruction, constipation, impaction ⃞ 12 – Dehydration, malnutrition ⃞ 13 – Urinary tract infection ⃞ 14 – IV catheter-related infection or complication ⃞ 15 – Wound infection or deterioration ⃞ 16 – Uncontrolled pain ⃞ 17 – Acute mental/behavioral health problem ⃞ 18 – Deep vein thrombosis, pulmonary embolus ⃞ 19 – Other than above reasons ⃞ UK – Reason unknown Instructional Guidance Instructions to Class Emergent Care

M2310 Emergent Care Reason (cont.) Identifies the reasons for which the patient sought care in a hospital emergency department If more than one reason contributed to the hospital emergency department visit, mark all appropriate responses For example, if a patient received care for a fall at home and was found to have medication side effects Mark both responses. Note response 2 is any fall, any time CMS Q & A October 2009 Question 27: If a patient goes to the hospital emergency department for a suspected DVT and scans/tests rule out DVT, is the correct response for M2310 #18 (Deep Vein Thrombosis, pulmonary embolus) or #19 (Other than above reasons)? Answer 27: M2310, Reason for Emergent Care, reports the reason the patient sought emergent care. In the situation you described, the patient sought care for a suspected DVT, even though the result of the evaluation was negative for a DVT, it was the reason they sought care and Response 18, Deep Vein Thrombosis, would be appropriate. CMS Q & A – April 2010 Question 39: OASIS-C reflects changed wording for the Emergent Care Reason Response 2 - Injury Cause by Fall. OASIS B-1 previously indicated Injury Caused by Fall or Accident at Home in answer 3 (M0840). When reviewing the response-specific instructions in Chapter 3 for M2310 an example is given indicating a fall at home. Is the intent of M2310 Response 2 for all falls or falls at home? Answer 39: M2310, Response 2 “Injury caused by fall” is no longer restricted to a fall at home. It should be selected when the patient sought care in the emergency room for an injury caused by any fall, anywhere, e.g. while at home, at the physician's office, church, etc. The home health agency should educate the patient and caregiver on fall prevention measures applicable to any location where the patient may be. The home health agency is responsible for preparing the patient for safety and function after discharge. Emergent Care

M2310 Emergent Care Reason (cont.) If the reason is not included in the choices, mark Response 19 – Other than above reasons If the patient has received emergent care in a hospital emergency department multiple times since the last time OASIS data were collected, include the reasons for all visits A new wound not caused by a fall would be “19 – Other than above reasons” OAI note: Add guidance below to slide. CMS Q & A from October 2009 Question 42: When completing M2310, Emergent Care Reason, if a patient seeks emergent care in the ER for a new wound that was not a result of a fall, should the reason be Response 15-Wound infection or deterioration or Response 19-Other than above reasons? Answer 42: The appropriate response would be “19-Other than above reasons” as Response 15 applies to an existing wound that becomes infected or deteriorates. Emergent Care

Questions??? E-mail: health.oasis@state.mn.us Cindy Skogen, RN; Oasis Education Coordinator 651-201-3818 Emergent Care