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March 20, 2008
Upcoming Hospital Report Card Act Deadlines
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Chief Executive Officers |
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Chief Nursing Executives |
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Quality Directors |
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Infection Control and Prevention Directors |
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Nurse Staff Hospital Report Card Act Contacts |
Just a quick reminder of some upcoming deadlines for hospital reporting of
Surgical Care Improvement Program (SCIP) and nurse staff data to meet the
Illinois Hospital Report Card Act reporting requirements.
SCIP Information Due March 31
SCIP data for all patient discharges during 4th Quarter 2007
are due for all hospitals, including Critical Access Hospitals, on Monday, March
31 at 11:59 p.m. Hospitals are required to report the following SCIP
information if applicable for all patients (including all payers, self-pay, and
uninsured patients) for the following measurements following the Center for
Medicare and Medicaid Services (CMS) specifications:
SCIP- Inf 1 – Prophylactic antibiotic received within one hour prior to
surgical incision
SCIP- Inf 2 – Prophylactic antibiotic selection for surgical patients
SCIP- Inf 3 – Prophylactic antibiotics discontinued within 24 hours after
surgery end time
Surgical outcome measures by reporting postoperative wound infection
diagnosed during index hospitalization using SCIP-Inf 1, SCIP-Inf 3, and
diagnoses codes reported.
SCIP Inf – 3b, 3c - Cardiac surgery patients with prophylactic antibiotics
discontinued within 48 hours after surgery
SCIP-Inf-4 - Cardiac surgery patients with controlled 6 a.m. postoperative
serum glucose
Vacancy Rate Information Due March 31
The vacancy rate for licensed nurses by clinical service area as of
January 1, 2008 must be submitted by Monday, March 31 at 11:59 p.m. Please note
that approximately 50% of Illinois hospitals have not submitted the vacancy rate
as of March 20.
All Illinois hospitals have had their primary nurse staff reporting
coordinators trained on the reporting requirements and how to enter the
information into the reporting system. Many hospitals have also had their
secondary coordinators trained as well in the event the primary nurse staff
reporting coordinator is not available. In recognition of staffing changes and
assignments, IHA will be routinely offering training to ensure that all hospital
staff charged with the responsibility of reporting this information are properly
trained on the reporting requirements.
Nurse Staff Information Due June 30th
Nurse staff reporting by inpatient clinical service area and optional
outpatient services are due on June 30, 2008 covering the 1st quarter
2008 time period. Hospitals can begin entering the information starting April 1,
2008 on the HRCA Nurse Staff Data Entry system. Hospitals are encouraged to not
wait until the last minute to enter information so they have ample time to make
any corrections or updates to the information.
Additional information on reporting requirements can be found on IHA’s web
site (click here). If you have additional questions
on nurse staff reporting, please send them to
nursestaffreporting@ihastaff.org and for questions on SCIP performance
measurements, please send them to
perfmeas@ihastaff.org.
Staff Contact: Pat Merryweather
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