Form Approved
OMB No. 0920-1290
Exp. Date: 09/30/2020
www.cdc.gov/nhsn
COVID-19 Module
Patient Impact and Hospital Capacity Pathway
Facility ID #: _____________
Summary Census ID #: _________
*Date for which patient impact and hospital capacity counts are reported: ____/____/________
For the following questions, please collect data at the same time (for example, 7 AM)
Section 1: Patient Impact Data Elements
_________ |
PREVIOUS DAY’S ADMISSIONS WITH CONFIRMED COVID-19: New patients admitted to an inpatient bed who had confirmed COVID-19 at the time of admission
|
_________ |
PREVIOUS DAY’S ADMISSIONS WITH SUSPECTED COVID-19: New patients admitted to an inpatient bed who had suspected COVID-19 at the time of admission
|
_________
_________ |
PREVIOUS DAY’S NEW HOSPITAL ONSET: Current inpatients hospitalized for a condition other than COVID-19 with onset of suspected or confirmed COVID-19 on the previous day and the previous day is fourteen or more days since admission
Number of Previous Day’s New Hospital Onset with Confirmed COVID-19 (subset)
|
_________
_________ |
HOSPITALIZED: Patients currently hospitalized in an inpatient bed who have suspected or confirmed COVID-19
Number of Hospitalized with Confirmed COVID-19 (subset)
|
_________
_________ |
HOSPITALIZED and VENTILATED: Patients currently hospitalized in an inpatient bed who have suspected or confirmed COVID-19 and are on a mechanical ventilator
Number of Hospitalized and Ventilated with Confirmed COVID-19 (subset)
|
_________ _________ |
HOSPITALIZED and ICU: Patients currently hospitalized in an inpatient ICU bed who have suspected or confirmed COVID-19
Number of Hospitalized and ICU with Confirmed COVID-19 (subset)
|
_________
_________ |
HOSPITAL ONSET: Total current inpatients with onset of suspected or confirmed COVID-19 fourteen or more days after admission for a condition other than COVID-19
Number of Hospital Onset with Confirmed COVID-19 (subset)
|
_________
_________ |
ED/OVERFLOW: Patients with suspected or confirmed COVID-19 who currently are in the Emergency Department (ED) or any overflow location awaiting an inpatient bed
Number of ED/Overflow with Confirmed COVID-19 (subset)
|
_________
_________ |
ED/OVERFLOW and VENTILATED: Patients with suspected or confirmed COVID-19 who currently are in the ED or any overflow location awaiting an inpatient bed and on a mechanical ventilator
Number of ED/Overflow and Ventilated with Confirmed COVID-19 (subset)
|
_________ _________ |
PREVIOUS DAY’S DEATHS: Patients with suspected or confirmed COVID-19 who died in the hospital, ED, or any overflow location on the previous calendar day
Number of Previous Day’s Deaths with Confirmed COVID-19 (subset)
|
Section 2: Hospital Bed/ Intensive Care Unit (ICU)/ Ventilator Capacity Data Elements
*Required for saving
V4
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Wattenmaker, Lauren (CDC/DDID/NCEZID/DHQP) |
File Modified | 0000-00-00 |
File Created | 2021-01-13 |