United States Health Information Knowledgebase

 

Surgery or Anesthesia


Form ID: F11
Form Name: Surgery or Anesthesia
Version: 1.1
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 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 for this release
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 1.1 03/31/2010 - -
DE456 Surgery procedure code 2 1.1 03/31/2010 - -
DE459 ASA documented class 3 1.1 03/31/2010 - -
DE462 Surgery performed as emergency 4 1.1 03/31/2010 - -
DE465 Timing of surgery event discovery 5 1.1 03/31/2010 - -
DE468 Total length of procedure 6 1.1 03/31/2010 - -
DE471 Type of anesthesia or sedation 7 1.1 03/31/2010 - -
DE474 Level of sedation 8 1.1 03/31/2010 - -
DE477 Person administering anesthesia 9 1.1 03/31/2010 - -
DE480 CRNA supervision by anesthesiologist 10 1.1 03/31/2010 - -
DE483 Specialty of provider who performed procedure 11 1.1 03/31/2010 - -
DE486 Description of surgery or anesthesia event 12 1.1 03/31/2010 - -
DE489 Major complication of surgery or anesthesia 13 1.1 03/31/2010 - -
DE492 Type of respiratory support provided 14 1.1 03/31/2010 - -
DE495 Unintentional retained object 15 1.1 03/31/2010 - -
DE498 Type of retained object 16 1.1 03/31/2010 - -
DE501 Count performed for retained object 17 1.1 03/31/2010 - -
DE504 Reported count status of retained object 18 1.1 03/31/2010 - -
DE507 X-ray before end of procedure to detect retained object 19 1.1 03/31/2010 - -
DE510 Retained object radiopaque 20 1.1 03/31/2010 - -
DE513 Characteristics of surgical adverse outcome 21 1.1 03/31/2010 - -
DE516 Occurrence of burn and/or operating room fire 22 1.1 03/31/2010 - -
DE519 Incorrect action for surgical or invasive procedure 23 1.1 03/31/2010 - -
DE522 Characterization of anesthesia event 24 1.1 03/31/2010 - -
DE525 Characteristics of airway management problem 25 1.1 03/31/2010 - -
Effective Date: 03/31/2010
Until Date: - -
Update Date: - -
Submitting Organization: Agency for Healthcare Research and Quality (AHRQ)
Date of Submission: 03/31/2010
Responsible Organization: Agency for Healthcare Research and Quality (AHRQ)
Creator: John C. Moquin
Data Steward: Agency for Healthcare Research and Quality
References: No specific reference at this time
Administrative Status: Final
Administrative Status Date: 03/31/2010
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