United States Health Information Knowledgebase

 

Surgery or Anesthesia


Form ID: F11
Form Name: Surgery or Anesthesia
Version: 1.2
Form Short Name: Surgery or Anesthesia
Synonym: Surgery
Definition: A surgical or anesthesia event involves surgery or other invasive procedures (e.g., colonoscopy) or the administration of anesthesia.
Setting: Hospitals, including outpatient pharmacies and outpatient departments located within the hospital
Language: U.S. English
Guide For Use: Use this form to report an event involving a surgical or other invasive procedure (e.g., colonoscopy), or the administration of anesthesia. Do not complete this form if the event involved the removal of organs from brain-dead patients (ASA Class 6) or handling an organ after procurement. If the event involved an anesthetic device, please also complete the Device or Medical/Surgical Supply, including Health Information Technology (HIT) form. If the event involved an anesthetic, medical gas, medication, or other substance, please also complete the Medication or Other Substance form. If the event involved a healthcare-associated infection, please also complete the Healthcare-associated Infection form. Narrative detail can be captured on the Healthcare Event Reporting Form (HERF).
Comments: None defined at this time
Description Of Change: Not Applicable
Data Element ID Sort Data Element Name Sort Question Number Sort Version Sort Effective Date Sort Until Date Sort
DE461 Description of procedure associated with event 1 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE456 Surgery procedure code 2 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE459 ASA documented class 3 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE462 Surgery performed as emergency 4 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE903 Type of anesthesia or sedation 5 Hospital Version 1.2 04/03/2012 - -
DE910 Type of anesthesia 6 Hospital Version 1.2 04/03/2012 - -
DE910 Type of anesthesia 7 Hospital Version 1.2 04/03/2012 - -
DE474 Level of sedation 8 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE474 Level of sedation 9 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE468 Total length of procedure 10 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE477 Person administering anesthesia or sedation 11 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE480 CRNA supervision by anesthesiologist 12 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE465 Timing of surgery event discovery 13 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE483 Specialty of provider or team who performed procedure 14 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE486 Description of surgery or anesthesia event 15 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE489 Major complication of surgery or anesthesia 16 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE492 Type of respiratory support provided 17 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE495 Unintentional retained object 18 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE498 Type of retained object 19 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE501 Count performed for retained object 20 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE504 Reported count status of retained object 21 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE507 X-ray before end of procedure to detect retained object 22 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE510 Retained object radiopaque 23 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE513 Characteristics of surgical adverse outcome 24 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE516 Occurrence of burn and/or operating room fire 25 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE519 Incorrect action for surgical or invasive procedure 26 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE522 Characterization of anesthesia event 27 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
DE525 Characteristics of airway management problem 28 Hospital Version 1.1, Hospital Version 1.2 03/31/2010 - -
Effective Date: 04/01/2012
Until Date: - -
Update Date: 04/24/2013
Submitting Organization: Agency for Healthcare Research and Quality (AHRQ)
Date of Submission: - -
Responsible Organization: Agency for Healthcare Research and Quality (AHRQ)
Creator: Amy Helwig, MD, MS
Data Steward: Agency for Healthcare Research and Quality
References: Not Applicable
Administrative Status: Final
Administrative Status Date: 01/24/2014
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