March 15th, 2021
In working with EasyReporting customers, we’ve come to realize that not everyone fully understands the values the NHSN is requiring in the Daily Entry. We published a more comprehensive post about all the current fields that are required, but felt it would be more meaningful to discuss the specific fields that are most commonly misunderstood.
Before we dive into the specific fields that can be problematic, lets first address a global problem over the entire dataset. Rolling counts have been an issue since the NHSN first started tracking COVID-19 data in 2020. This issue occurs when a facility manager counts a positive resident in one reporting window, and it accidentally rolls to the next reporting window as well. It’s easy to understand how a mistake like this could occur. Before using EasyReporting, many of our customers track COVID data in a spreadsheet. When all the data has been identified, it’s hard to remember which residents were counted in which numbers. EasyReporting solves this problem in two ways:
- Reporting Window The NHSN has been vocal about requesting providers submit data on a daily basis. That’s what it is called the “Daily Entry”. The bare minimum is once a week; and that is what the CMP (fines) can be issued for. Having said that, many of our customers submit twice a week (or three times in some cases). This makes avoiding “rolling counts” much more difficult given the reporting windows are changing. EasyReporting manages reporting windows flawlessly. We know when a reporting window begins and ends; down to the millisecond. This allows to calculate the NHSN dataset with a high level of precision.
- Rolling Counts When EasyReporting puts a “3” in your COVID positive dataset we know exactly who those three residents (or staff) are. We have unique identifiers for every person we track. Of course none of the identifiable information shows on the NHSN’s report, but if ever audited we can prove how we calculated each number.
Also worth noting, the most significant update the NHSN made to the dataset was the update on November 23rd, 2020. We’ll refer to this in shorthand by “11/2020”. That’s the update where flu and respiratory disorders were included in the required dataset.
numrespostest
numrespostest is the number of positive COVID-19 tests within the reporting window. This change was a big shift away from the old metric numresconfc19. This was part of the 11/2020 update. It was significant statement that providers were no longer responsible for determining if a resident had a confirmed case of COVID-19; instead the NHSN put the focus directly on testing. This trend has continue to evolve as the NHSN’s relationship becomes more direct with testing devices/parties.
numresdied & numresc19died
numresdied is the number of deceased residents within the reporting window, and
numresc19died is the number of those residents with a positive COVID-19 diagnosis.
This is not a cause of death conclusion, it’s simply an observatory metric.
Why is this metric on the misunderstood list? Look at the NHSN’s definition: “Of the number of reported Total Deaths, report the number of residents with COVID-19 who died in the facility or another location.” It is really difficult for providers to track residents once they are transferred out of their facility. It takes discipline to track down outcomes outside your facility, log them in your EHR, and report them to the NHSN. This is why a tool like EasyReporting is so helpful in reporting accurate data.
numressuspc19
This is the “suspected residents” metric. This metric is no longer part of the required dataset. I’m curious if it is because this metric is so subjective, leading to inaccuracy. There is really no concrete way to prove a resident is suspected of having COVID. Maybe this metric was more meaningful when providers were forced to used outsourced lab results that would take 5-7 days to return. Despite this metric no longer being in the submitted NHSN dataset, EasyReporting still calculates it. We use the residents previous health history, facility outbreak data, and proximity to calculate how likely it is a resident has COVID-19.
numressuspc19
This is the “suspected residents” metric. This metric is no longer part of the required dataset. I’m curious if it is because this metric is so subjective, leading to inaccuracy. There is really no concrete way to prove a resident is suspected of having COVID. Maybe this metric was more meaningful when providers were forced to used outsourced lab results that would take 5-7 days to return. Despite this metric no longer being in the submitted NHSN dataset, EasyReporting still calculates it. We use the residents previous health history, facility outbreak data, and proximity to calculate how likely it is a resident has COVID-19.
numrespostestposag
“Of the number of reported residents above with a Positive Test, how many were tested using positive SARS-CoV-2 antigen test only (no other testing performed)”.
Although there are some exciting developments around PCR-based POC devices, most (if not all) POC devices in facilities are antigen-based. This metric can be tricky because you have to ensure that the resident doesn’t have any other test sources, like a PCR-based outsourced lab result. This typically isn’t the case because providers stop testing as soon as a positive diagnosis is discovered, but some providers will PCR test a positive resident to see if it is a false-negative. In the event this resident has a mix of testing, they should not be counted towards this metric. This is some pretty tricky logic for a human to keep track of calculate, that’s why we leave the heavy lifting to the logic in EasyReporting.
numResPosTestPosAgNegNAAT
“Of the number of reported residents above with a Positive Test, how many were tested using positive SARS-CoV-2 antigen test and negative SARS CoV-2 NAAT (PCR)”.
Another difficult metric to calculate. If you only have twenty residents in your facility this might be something you can keep track of, but when you start hitting 110-120 residents, it makes it really difficult to calculate this metric. Especially if you have outsourced lab results in the mix and you are reporting twice a week.
c19nonpoctestresults
“During the past two weeks, on average, how long did it take your LTCF to receive SARS-CoV-2 (COVID-19) viral test results of staff and/or facility personnel?”.
Notice that this metric is not mapped to the reporting window; the time window to calculate this metric is the last 14 days. At EasyReporting, we focus on accuracy. This is the one metric that is not linked to the reporting window in any way. Instead we calculate the exact latency on your outsourced/PCR lab results, from the time the sample is received to the time the test results are published.