If a patient is transferred out, even with no injuries being found at the transferring hospital, why would that not be considered PTOS? The inclusion criteria states “all transfers in and out”, and if the injury does not fall under any of the exclusions, it should be PTOS. There was one specific incident where there was a traumatic injury and the patient was transferred out for continuity of care due to a cancer diagnosis. There was a traumatic injury, so why would that not be included? The transferring facility should count that as PTOS although the receiving facility may find or verify no injuries and/or discharge from the ED.
Also, for patients with traumatic injuries that are admitted for, let’s say, ambulatory dysfunction, dehydration, etc. – Help us understand why this would not be PTOS. The patient is being treated for their traumatic injuries as well as any other comorbid condition(s). The inclusion criteria states that trauma patients are defined as “patients remaining at your facility for the treatment or diagnosis of trauma”. If a patient has a humerus fx, is admitted >36 hours, why would it not be PTOS even if the injury is non-operative and/or they are admitted for the “reason” they sustained the injury? This is especially true for our geriatric patients for obvious reasons, or for patients with rib fxs, etc. who are admitted for pain control, inability to care for themselves . . . .
For any patient to be PTOS, the patient must first have a diagnosis that falls into the ICD-10 inclusion range. Patient’s with no injuries are only included if they die or meet the transfer out criteria with no documented injuries as death or rapid transfer can prevent the opportunity to confirm clinical diagnoses. Therefore, trauma patients who expire or meet the transfer out criteria with no documented injuries should be captured as PTOS patients. NOTE: Patients who do not have any documented injury diagnoses within the PTOS inclusion criteria ICD-10 code range after a workup, including imaging studies, are to be excluded from PTOS. These patients may be captured as nonPTOS in your facility’s trauma registry.
In the example of the cancer patient with a traumatic injury, it is possible the patient would be captured as PTOS. It really depends on the injury. If the injury was resolved prior to transfer and the only reason for transfer is the cancer diagnosis, the patient would not be PTOS because if it were not for the cancer diagnosis, the patient would not be a transfer patient and would not meet the PTOS inclusion criteria. If the injury is still active and requires treatment at the receiving facility, the patient can certainly be included as PTOS. If the receiving facility finds no injuries that fall within the ICD-10 inclusion range, they would not count the patient as PTOS. Remember, in order to be PTOS the patient must first have a diagnosis that falls within the ICD-10 code range. They are not counted simply because they were a transfer.
The same logic kind of applies to patients that are admitted for medical reasons. For example, if the patient’s injury is resolved in the ED but they are admitted for a medical reason, they would not have met PTOS criteria if it were not for the medical admission. If the injury is still actively being treated during the admission and was part of the reason for admission, the patient can certainly be included as PTOS. Think of a patient that falls and breaks their arm. They are x-rayed and casted in the ED and told to follow-up in two weeks. However, this patient has uncontrolled diabetes and is admitted. The diabetes is the reason for admission and what is being actively treated during the admission. If it wasn’t for the diabetes, the patient would have went home from the ED and not met PTOS criteria. Patients with rib fractures who are waiting for placement or admitted for pain control should be captured as PTOS. I’m sure if they are geriatric they have other co-morbids, but if the reason for admission was the injury or due to the injury, they should be considered for PTOS.
It is definitely not black and white. If you have other specific examples with documentation you would like us to review, please let me know. We’re happy to do so!