| 1 | English French Notes Complete/Exclude
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| 2 | 8. Other Procedures CPT Code:
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| 3 | 9. Preoperative Risk Factors:
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| 4 | 10. Cardiac Surgery to Non-VA Facility:
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| 5 | Select Operative Risk Summary Information to Edit:
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| 6 | 2. Enter the corresponding number to update the information in a particular
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| 7 | field. (For example, enter '3' to update Surgical Priority)
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| 8 | 3. Enter two numbers separated by a ':' to enter a range of information.
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| 9 | (For example, enter '1:2' to update Physician's Preoperative Estimate of
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| 10 | Mortality and ASA Classification.)
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| 11 | Enter/Edit Patient Resource Data
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| 12 | 1. Capture Information from PIMS Records
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| 13 | 2. Enter, Edit, or Review Information
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| 14 | Enter '1' if you want to capture patient information from PIMS
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| 15 | records. Enter '2' if you want to enter, edit, or review patient
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| 16 | other information on this screen.
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| 17 | No Study
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| 18 | Unable to determine
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| 19 | Remains intubated at 30 days
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| 20 | Remains in ICU at 30 days
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| 21 | Are you sure you want to retrieve information from PIMS records ?
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| 22 | 4. Enter 'N' or 'NO' to enter negative response for all items.
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| 23 | 5. Enter '@' to delete information from all items.
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| 24 | To identify the date and time the patient was discharged from intensive
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| 25 | care following surgery, see the following list of patient movements
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| 26 | that occurred during the inpatient stay associated with this surgery.
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| 27 | CABG Distal Anastomoses
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| 28 | 14. Cardiac Transplant:
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| 29 | 1. Number with Vein:
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| 30 | 15. Electrophysiologic Procedure:
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| 31 | 2. Number with IMA:
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| 32 | 16. Misc. Cardiac Procedures:
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| 33 | 3. Number with Radial Artery:
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| 34 | A. ASD Repair:
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| 35 | 4. Number with Other Artery:
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| 36 | B. VSD Repair:
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| 37 | 5. Number with Other Conduit:
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| 38 | C. Myxoma Resection:
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| 39 | D. Foreign Body Removal:
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| 40 | 6. Aortic Valve Replacement:
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| 41 | E. Myectomy for IHSS:
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| 42 | 7. Mitral Valve Replacement:
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| 43 | 8. Tricuspid Valve Replacement:
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| 44 | G. Other Tumor Resection:
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| 45 | 9. Valve Repair:
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| 46 | H. Other Procedure(s):
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| 47 | 10. LV Aneurysmectomy:
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| 48 | 17. Minimally Invasive Procedure:
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| 49 | 11. Great Vessel Repair (Req CPB):
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| 50 | 18. Batista Procedure:
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| 51 | 12. Total Ischemic Time:
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| 52 | 19. Incision Type:
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| 53 | 13. Total CPB Time:
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| 54 | 20. Convert Off Pump to CPB:
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| 55 | * Other Procedures List:
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| 56 | Miscellaneous Cardiac Procedures
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| 57 | Sure you want to delete all Misc. Cardiac Procedures information ?
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| 58 | 1. Operative Death:
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| 59 | 2. Date of Death:
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| 60 | 3. Perioperative MI:
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| 61 | 5. Renal Failure Requiring Dialysis:
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| 62 | 6. Low Cardiac Output > or = 6 Hours:
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| 63 | 8. Reoperation for Bleeding:
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| 64 | 9. On Ventilator > or = 48 Hours:
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| 65 | 10. Repeat Cardiopulmonary Bypass:
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| 66 | 13. Cardiac Arrest Requiring CPR:
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| 67 | PAGE: 2 OF 2
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| 68 | 1. WOUND COMPLICATIONS:
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| 69 | 4. CNS COMPLICATIONS:
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| 70 | A. Superficial Infection:
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| 71 | A. Cerebral Vascular Accident:
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| 72 | B. Deep Wound Infection:
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| 73 | C. Wound Dehiscence:
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| 74 | C. Neurological Deficits:
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| 75 | 2. RESPIRATORY COMPLICATIONS:
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| 76 | 5. CARDIAC COMPLICATIONS:
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| 77 | A. Arrest Requiring CPR:
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| 78 | B. Unplanned Intubation:
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| 79 | B. Myocardial Infarction:
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| 80 | C. Pulmonary Embolism:
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| 81 | C. Pulmonary Edema:
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| 82 | D. On Ventilator > 48 Hours:
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| 83 | 3. URINARY TRACT COMPLICATIONS:
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| 84 | 6. OTHER COMPLICATIONS:
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| 85 | A. Renal Insufficiency:
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| 86 | A. Ileus/Bowel Obstruction:
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| 87 | B. Acute Renal Failure:
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| 88 | C. Urinary Tract Infection:
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| 89 | C. Graft/Prosthesis Failure:
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| 90 | E. Systemic Sepsis:
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| 91 | mm Hg
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| 92 | 2. Aortic Systolic Pressure:
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| 93 | 3. *PA Systolic Pressure:
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| 94 | 4. *PAW Mean Pressure:
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| 95 | 5. Left Main Stenosis:
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| 96 | 6. LAD Stenosis:
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| 97 | 7. Right Coronary Stenosis:
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| 98 | 8. Circumflex Stenosis:
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| 99 | 9. LV Contraction Grade (from contrast
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| 100 | or radionuclide angiogram or 2D echo):
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| 101 | 10. Mitral Regurgitation:
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| 102 | II 0.45-0.54 MILD DYSFUNCTION
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| 103 | III 0.35-0.44 MODERATE DYSFUNCTION
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| 104 | IIIa 0.40-0.44 MODERATE DYSFUNCTION A
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| 105 | IIIb
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| 106 | IIIb 0.35-0.39 MODERATE DYSFUNCTION B
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| 107 | IV 0.25-0.34 SEVERE DYSFUNCTION
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| 108 | V <0.25 VERY SEVERE DYSFUNCTION
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| 109 | NO LV STUDY
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| 110 | This assessment has already been verified and transmitted. It cannot be
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| 111 | deleted. If the assessment was transmitted in error, use the option 'Update
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| 112 | an Assessment Transmitted in Error'.
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| 113 | This assessment has already been verified. It cannot be deleted. If the
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| 114 | assessment was verified in error, use the option 'Update an Assessment Verified
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| 115 | in Error'.
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| 116 | This assessment has a current status of
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| 117 | Enter <RET> if this assessment was selected in error and should not be deleted.
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| 118 | If you want to delete this assessment, enter 'YES'.
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| 119 | Deleting Assessment...
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| 120 | SUPERVISOR CODES: 1-STAFF CASE, 2-STAFF ASSISTED BY RESIDENT OR C.R.N.A., 3-STAFF ASSISTING C.R.N.A., 4-STAFF ASSISTING RESIDENT
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| 121 | 5-STAFF CONSULTING IN OR, 6-STAFF AVAILABLE IN OR SUITE, 7-STAFF AVAILABLE IN HOSP./UNIV. COMPLEX
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| 122 | 8-STAFF CALLED FOR EMERGENCY, 9-C.R.N.A. INDEPENDENT DUTY MD/DDS SUP.
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| 123 | Anesthesia Provider Report
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| 124 | Do you want to print the report for all Anesthesia Providers ? YES//
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| 125 | Enter RETURN to print the report for all anesthesia providers, or 'NO'
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| 126 | to select a specific anesthesia provider.
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| 127 | Print the report for which Anesthesia Provider ?
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| 128 | ANESTHESIA PROVIDER REPORT
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| 129 | SRPRO*
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| 130 | ASA CLASS
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| 131 | LEVEL OF SUPERVISION
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| 132 | RELIEF ANESTH
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| 133 | PRINCIPAL TECHNIQUE
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| 134 | ELAPSED ANES TIME
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| 135 | ASST ANESTH
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| 136 | ANESTHESIA AGENT
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| 137 | Press RETURN to continue, '^' to quit
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| 138 | Are you sure that you want to change the status of this assessment
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| 139 | The Assessment Status has been changed to 'INCOMPLETE'.
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| 140 | This assessment already has the status, 'INCOMPLETE'.
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| 141 | Enter RETURN if the assessment was
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| 142 | in error and the status
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| 143 | should be changed to 'INCOMPLETE' to allow editing. Otherwise, enter 'NO'.
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| 144 | ADD ON TODAY (NONEMERGENT)
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| 145 | 1. Exclusion Criteria:
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| 146 | 2. Surgical Priority:
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| 147 | 3. Surgical Specialty:
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| 148 | 4. Principal Operation (CPT):
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| 149 | 5. Principal Anesthesia Technique:
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| 150 | 6. Major or Minor:
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| 151 | Select Excluded Case Information to Edit:
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| 152 | 2. Enter a number (1-6) to update the information in that field. (For
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| 153 | example, enter '2' to update Surgical Priority)
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| 154 | 3. Enter a range of numbers (1-6) separated by a ':' to enter a range of
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| 155 | information. (For example, enter '1:2' to update the Exclusion Criteria
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| 156 | and Surgical Priority)
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| 157 | Reason for not Creating an Assessment
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| 158 | This selection loads the most recent lab data for tests performed
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| 159 | within 90 days before the operation.
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| 160 | Do you want to automatically load preoperative lab data ? YES//
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| 161 | Enter <RET> to automatically load preoperative lab data from the patient's lab record, or 'NO' to return to the menu.
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| 162 | Lab data NOT loaded.
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| 163 | The 'Time the Operation Began' must be entered before continuing.
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| 164 | ..Searching lab record for latest preoperative test data....
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| 165 | Do you want to enter 'Time the Operation Began' at this time ? YES//
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| 166 | The time that the operation began must be entered prior to capturing the
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| 167 | preoperative lab data. Enter 'YES' to input 'Time the Operation Began',
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| 168 | or 'NO' to return to the menu.
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| 169 | ..Moving preoperative lab test data to Surgery Risk Assessment file....
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| 170 | This selection loads highest or lowest lab data for tests performed within
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| 171 | 30 days after the operation.
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| 172 | Do you want to automatically load postoperative lab data ? YES//
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| 173 | Enter <RET> to automatically load postoperative lab data from the patient's lab record, or 'NO' to return to the menu.
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| 174 | 'Time the Operation Ends' must be entered before continuing.
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| 175 | ..Searching lab record for postoperative lab test data....
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| 176 | Do you want to enter the time that the operation was completed at
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| 177 | this time ? YES//
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| 178 | Enter 'YES' to input 'Time the Operation Ends' or
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| 179 | 'NO' to return to the menu.
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| 180 | ..Moving postoperative lab data to Surgery Risk Assessment file....
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| 181 | You must select a surgery risk assessment prior to using this option.
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| 182 | Enter/Edit Laboratory Test Results
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| 183 | 1. Capture Preoperative Laboratory Information
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| 184 | 2. Capture Postoperative Laboratory Information
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| 185 | 3. Enter, Edit, or Review Laboratory Test Results
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| 186 | Enter '1' if you want to capture preoperative laboratory test results from the
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| 187 | DHCP Laboratory records. Enter '2' if you want to capture the postoperative
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| 188 | laboratory test results from the DHCP Laboratory records. If you want to
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| 189 | enter, edit, or review preoperative and postoperative laboratory test results,
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| 190 | If you want to continue listing incomplete assessments, enter <RET>. Enter
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| 191 | '^' to return to the menu.
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| 192 | COMPLETED RISK ASSESSMENTS
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| 193 | ASSESSMENT #
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| 194 | OPERATION DATE
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| 195 | PRINCIPAL OPERATION
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| 196 | ANESTHESIA TECHNIQUE
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| 197 | SURGERY SERVICE
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| 198 | PRINCIPAL OPERATIVE PROCEDURE
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| 199 | DATE COMPLETED
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| 200 | ** SURGICAL SPECIALTY:
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| 201 | PAGE: 1 OF 2
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| 202 | PREOP LABORATORY RESULTS
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| 203 | LATEST PREOP LAB RESULTS IN 90 DAYS PRIOR TO SURGERY
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| 204 | 1. Serum Sodium:
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| 205 | 3. Serum Creatinine:
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| 206 | 4. Serum Albumin:
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| 207 | 5. Total Bilirubin:
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| 208 | 7. Alkaline Phosphatase:
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| 209 | 10. Platelet Count:
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| 210 | Select Preoperative Laboratory Information to Edit:
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| 211 | 2. Enter a number (1-12) to update the information in that field. (For
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| 212 | example, enter '2' to update Preoperative BUN)
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| 213 | 3. Enter a range of numbers (1-12) separated by a ':' to enter a range of
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| 214 | BUN, and Serum Creatinine)
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| 215 | Report of Monthly Case Workload Totals
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| 216 | This option provides a report of the monthly risk assessment surgical case
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| 217 | workload totals for the following categories:
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| 218 | 1. All cases performed
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| 219 | 2. Excluded cases
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| 220 | 3. Assessed cases
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| 221 | 4. Non-assessed cases
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| 222 | 5. Cardiac cases
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| 223 | 6. Non-cardiac cases
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| 224 | 7. Assessed cases per day (based on 20 days/month)
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| 225 | This report may be printed and/or transmitted to the national database.
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| 226 | Compile workload totals for which month and year?
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| 227 | Enter the month and year for which to run this report,
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| 228 | for example, 'MAY 94', 'MAY 1994', '5/94' or '5 94'.
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| 229 | Compile totals for
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| 230 | Do you want this report to be transmitted to the central database
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| 231 | Enter YES to have this report automatically transmitted to the central
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| 232 | database. Enter NO if you do NOT want this report transmitted.
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| 233 | Do you also want to print this report
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| 234 | Enter NO if you want to have this report transmitted, but do not want to
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| 235 | have it printed. Enter YES if you do want to print the report as well as
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| 236 | have it transmitted.
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| 237 | Print report on which Device:
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| 238 | Report of Surgical Case Workload
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| 239 | Queue report to run at what date/time?
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| 240 | One month ago, you had an operation at the VA Medical Center. We are
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| 241 | interested in how you feel. Have you had any health problems since your
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| 242 | operation ? We would like to hear from you. Please take a few minutes
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| 243 | to answer these questions and return this letter in the self-addressed
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| 244 | stamped envelope.
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| 245 | Have you been to a hospital or seen a doctor for any reason since your
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| 246 | If you answered NO, you do not need to answer any more questions. Please
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| 247 | return this sheet in the self-addressed stamped envelope.
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| 248 | If you have answered YES, please answer the following questions.
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| 249 | 1) Have you been seen in an outpatient clinic or doctor's office ?
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| 250 | Why did you go to the clinic or doctor's office ? ________________
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| 251 | Where ? (name and location) _____________________ Date ? ________
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| 252 | Who was your doctor ? ____________________________________________
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| 253 | 2) Were you admitted to a hospital ? ___ Yes ___ No
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| 254 | Why did you go to the hospital ? _________________________________
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| 255 | Please return this letter whether or not you have had any medical problems.
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| 256 | Your health and opinion are important to us. Thank You.
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| 257 | Surgical Clinical Nurse Reviewer
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| 258 | NO ASSESSMENT
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| 259 | CPT CODE MISSING
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| 260 | NON-ASSESSED MAJOR SURGICAL CASES BY SURGICAL SPECIALTY
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| 261 | ALL MAJOR SURGICAL CASES BY SURGICAL SPECIALTY
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| 262 | OPERATIVE PROCEDURE(S)
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| 263 | ASSESSMENT STATUS
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| 264 | EXCLUSION CRITERIA
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| 265 | PRINCIPAL CPT CODE
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| 266 | NON-ASSESSED MAJOR SURGICAL CASES
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| 267 | ALL MAJOR SURGICAL CASES
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| 268 | SRA,$J)
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| 269 | TOTAL MAJOR CASES FOR ALL SPECIALTIES:
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| 270 | If you want to continue listing assessments, enter <RET>. Enter '^' to
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| 271 | return to the menu.
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| 272 | TOTAL CASES FOR ALL SPECIALTIES:
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| 273 | SURGICAL SPECIALTY:
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| 274 | COMPLETED/TRANSMITTED ASSESSMENTS MISSING INFORMATION
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| 275 | NON-CARDIAC
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| 276 | Missing information:
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| 277 | OPERATION(S)
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| 278 | TOTAL FOR ALL SPECIALTIES:
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| 279 | Select Postoperative Laboratory Information to Edit:
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| 280 | example, enter '5' to update Highest Serum Creatinine)
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| 281 | Lowest Serum Sodium, and Highest Potassium)
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| 282 | POSTOP LAB RESULTS WITHIN 30 DAYS AFTER SURGERY
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| 283 | 1. Highest Serum Sodium:
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| 284 | 2. Lowest Serum Sodium:
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| 285 | 3. Highest Potassium:
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| 286 | 4. Lowest Potassium:
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| 287 | 5. Highest Serum Creatinine:
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| 288 | 6. Highest CPK:
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| 289 | 7. Highest CPK-MB Band:
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| 290 | 8. Highest Total Bilirubin:
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| 291 | 9. Highest WBC:
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| 292 | 10. Lowest Hematocrit:
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| 293 | 11. Highest Troponin I:
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| 294 | 12. Highest Troponin T:
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| 295 | Select Operation:
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| 296 | Enter the number corresponding to the surgical case for which you will be
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| 297 | creating a surgical risk assessment.
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| 298 | 1. Enter Information
|
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| 299 | 2. Review Information
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| 300 | 3. Delete Surgery Case
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| 301 | Select Number: 1//
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| 302 | Enter RETURN or '1' to enter or edit information contained within one of the
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| 303 | #################### #################### ####################
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| 304 | #################### #################### ####################
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| 305 | #################### #################### ####################
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| 306 | #################### #################### ####################
|
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| 307 | #################### #################### ####################
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