Hospital service—care type, code N[N]

Guide for use:

Only one type of care can be assigned at a time. In cases when a patient is receiving multiple types of care, the care type that best describes the primary clinical purpose or treatment goal should be assigned.

The care type is assigned by the clinician responsible for the management of the care, based on clinical judgements as to the primary clinical purpose of the care to be provided and, for subacute care types, the specialised expertise of the clinician who will be responsible for the management of the care. At the time of subacute care type assignment, a multidisciplinary management plan may not be in place but the intention to prepare one should be known to the clinician assigning the care type.

Where the primary clinical purpose or treatment goal of the patient changes, the care type is assigned by the clinician who is taking over responsibility for the management of the care of the patient at the time of transfer. Note, in some circumstances the patient may continue to be under the management of the same clinician. Evidence of care type change (including the date of handover, if applicable) should be clearly documented in the patient’s medical record.

The clinician responsible for the management of care may not necessarily be located in the same facility as the patient. In these circumstances, a clinician at the patient's location may also have a role in the care of the patient; the expertise of this clinician does not affect the assignment of care type.

The care type should not be retrospectively changed unless it is:

• for the correction of a data recording error, or
• the reason for change is clearly documented in the patient’s medical record and it has been approved by the hospital’s director of clinical services.

Subacute care is specialised multidisciplinary care in which the primary need for care is optimisation of the patient’s functioning and quality of life. A person’s functioning may relate to their whole body or a body part, the whole person, or the whole person in a social context, and to impairment of a body function or structure, activity limitation and/or participation restriction.

Subacute care comprises the defined care types of rehabilitation, palliative care, geriatric evaluation and management and psychogeriatric care.

A multidisciplinary management plan comprises a series of documented and agreed initiatives or treatments (specifying program goals, actions and timeframes) which has been established through multidisciplinary consultation and consultation with the patient and/or carers.

It is highly unlikely that, for care type changes involving subacute care types, more than one change in care type will take place within a 24-hour period. Changes involving subacute care types are unlikely to occur on the date of formal separation.

Patients who receive acute same-day intervention(s) during the course of a subacute episode of care do not change care type. Instead, procedure codes for the acute same-day intervention(s) and an additional diagnosis (if relevant) should be added to the record of the subacute episode of care.

Palliative care episodes can include grief and bereavement support for the family and carers of the patient where it is documented in the patient’s medical record.

Context:

Admitted patient care and hospital activity:

For admitted patients, the type of care received will determine the appropriate casemix classification employed to classify the episode of care.