CMS-10210 CAUTI Validation Template

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Overview

Definitions
Template
NHSN ICU Location

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Sheet 1: Definitions

Catheter-Associated Urinary Tract Infection (CAUTI) Validation Template In support of validation for the Hospital Inpatient Quality Reporting Program for the Fiscal Year (FY) 2017 Payment determination. • Each hospital selected for CAUTI validation is to produce a list of positive urine cultures for intensive care unit (ICU) patients. • The line list should include all final results for all positive urine cultures with >= 10³ colony-forming units (CFUs)/ml collected during an ICU stay. • For each patient confirm the patient had: 1) An ICU admission during this hospital stay; and 2) A positive urine culture collected during the ICU stay with >= 10³ CFU/ml. (Exclude positive cultures with more than 2 organisms present even if results are >=10³ CFU/ml.)
FY 2017 - CAUTI Validation Template (positive urine cultures for discharges beginning 3Q14)
FIELD (* indicates required field)	DESCRIPTION	SECTION
NHSN Facility ID*	The National Healthcare Safety Network (NHSN)-assigned facility ID under which your hospital submits NHSN data.	Hospital Information Section Complete the first row in the spreadsheet. The information provided in the first row will be applied to all positive urine cultures listed on the template.
Provider ID/CCN*	Hospitals CMS Certification Number.
Hospital Name*	Hospital Name associated with CCN.
State*	Enter the 2 character abbreviation for the state in which the hospital is located.
Calendar Quarter*	Select from the dropdown list the calendar quarter to which the CAUTI Validation Template pertains.
Hospital Contact Name*	Hospital contact name for CMS to contact with questions.
Contact Phone*	Phone number for hospital contact listed.
Contact Email*	Email address for hospital contact listed.
Positive Urine Cultures (Y/N)*	Select Yes or No from the dropdown list. Does the hospital have any final results for positive urine cultures for ICU patients in the calendar quarter referenced?
Patient HIC*	The patient's Medicare Beneficiary Number, also known as the health insurance claim (HIC) number. No dashes, spaces or special characters should be included. Must be between 7 and 12 characters. This field is required for Medicare patients when the HIC number is known. Leave blank if not applicable.	Urine Culture Section Complete for every final positive urine culture.
Patient Identifier*	The patient identifier assigned by the hospital. Use the same patient identifier that would be submitted to NHSN if the episode of care (EOC) would be reported as a CAUTI event.
Birthdate*	The patient date of birth using MM/DD/YYYY format.
Sex*	Select Female, Male or unknown from the dropdown list to indicate the sex of patient.	Patient Information Section Complete once per patient episode of care.
Admit Date*	Enter date patient was admitted to hospital in MM/DD/YYYY format.
Discharge Date*	Enter date patient was discharged from the hospital in MM/DD/YYYY format. If a patient has not been discharged from the hospital enter ‘Not Discharged’ for the Discharge Date field.
First Name	First name of patient.
Last Name	Last name of patient.
NHSN ICU Location*	Select from the drop down list, the NHSN ICU location to which the patient was assigned when the positive urine culture was collected. Include only cultures collected during an ICU stay.	Urine Culture Section Complete for every final positive urine culture.
Lab ID*	Lab ID, accession number or specimen number corresponding to positive urine culture.
Urine Culture Date*	Provide the date the urine culture was collected in MM/DD/YYYY format.
Urine Culture Time	Provide the time the urine was collected if easily available.
End of spreadsheet

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Sheet 2: Template

NHSN Facility ID*

Provider ID/CCN*

Hospital Name*

State*

Calendar Quarter*

Hospital Contact Name*

Contact Phone*

Contact Email*

Positive Urine Cultures (Y/N)*

Patient HIC*

Patient Identifier*

Birthdate*

Sex*

Admit Date*

Discharge Date*

First Name

Last Name

NHSN ICU Location*

Lab ID*

Urine Culture Date*

Urine Culture Time

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Sheet 3: NHSN ICU Location

NHSN Locations Included in the Hospital IQR Program's CAUTI Reporting
	CDC DESCRIPTION	DETAILS	CDC CODE
Inpatient Adult Critical Care Units	Burn Critical Care	Critical care area specializing in the care of patients with significant/major burns.	IN:ACUTE:CC:B
	Medical Cardiac Critical Care	Critical care area specializing in the care of patients with serious heart problems that do not require heart surgery.	IN:ACUTE:CC:C
	Medical Critical Care	Critical care area for patients who are being treated for nonsurgical conditions.	IN:ACUTE:CC:M
	Medical/Surgical Critical Care	An area where critically ill patients with medical and/or surgical conditions are managed.	IN:ACUTE:CC:MS
	Neurologic Critical Care	Critical care area for the care of patients with life-threatening neurologic diseases.	IN:ACUTE:CC:N
	Neurosurgical Critical Care	Critical care area for the surgical management of patients with severe neurologic diseases or those at risk for neurologic injury as a result of surgery.	IN:ACUTE:CC:NS
	ONC Medical Critical Care	Critical care area for the care of oncology patients who are being treated for nonsurgical conditions related to their malignancy.	IN:ACUTE:CC:ONC_M
	ONC Surgical Critical Care	Critical care area for the evaluation and management of oncology patients with serious illness before and/or after cancer-related surgery.	IN:ACUTE:CC:ONC_S
	ONC Medical-Surgical Critical Care	Critical care area for the care of oncology patients with medical and/or surgical conditions related to their malignancy.	IN:ACUTE:CC:ONC_MS
	Prenatal Critical Care	Critical care area for the care of pregnant patients with complex medical or obstetric problems requiring a high level of care to prevent the loss of the fetus and to protect the life of the mother.	IN:ACUTE:CC:PNATL
	Respiratory Critical Care	Critical care area for the evaluation and treatment of patients with severe respiratory conditions.	IN:ACUTE:CC:R
	Surgical Cardiothoracic Critical Care	Critical care area specializing in the care of patients following cardiac and thoracic surgery.	IN:ACUTE:CC:CT
	Surgical Critical Care	Critical care area for the evaluation and management of patients with serious illness before and/or after surgery.	IN:ACUTE:CC:S
	Trauma Critical Care	Critical care area specializing in the care of patients who require a high level of monitoring and/or intervention following trauma or during critical illness related to trauma.	IN:ACUTE:CC:T
Inpatient Pediatric Critical Care Units	Pediatric Burn Critical Care	Critical care area specializing in the care of patients ≤ 18 years old with significant/major burns.	IN:ACUTE:CC:B_PED
	Pediatric Cardiothoracic Critical Care	Critical care area specializing in the care of patients ≤ 18 years old following cardiac and thoracic surgery.	IN:ACUTE:CC:CT_PED
	Pediatric Medical Critical Care	Critical care area for patients ≤ 18 years old who are being treated for nonsurgical conditions. In the NNIS system, this was called Pediatric ICU (PICU).	IN:ACUTE:CC:M_PED
	Pediatric Medical Surgical Critical Care	An area where critically ill patients ≤ 18 years old with medical and/or surgical conditions are managed.	IN:ACUTE:CC:MS_PED
	Pediatric Neurosurgical Critical Care	Critical care area specializing in the surgical management of patients ≤ 18 years old with severe neurological diseases or those at risk for neurological injury as a result of surgery.	IN:ACUTE:CC:NS_PED
	Pediatric Respiratory Critical Care	Critical care area for the evaluation and treatment of the patients ≤ 18 years old with severe respiratory conditions.	IN:ACUTE:CC:R_PED
	Pediatric Surgical Critical Care	Critical care area for the evaluation and management of patients ≤ 18 years old with serious illness before and/or after surgery.	IN:ACUTE:CC:S_PED
	Pediatric Trauma Critical Care	Critical care area specializing in the care of patients ≤ 18 years old who require a high level of monitoring and/or intervention following trauma or during critical illness related to trauma.	IN:ACUTE:CC:T_PED
End of spreedsheet