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Appendix ZZ-Multiple Record Discharges

Extensive services provided during a hospitalization may result in multiple discharge records being created for a single patient stay. The extra records, referred to as "continuation records", are needed when there is more accommodation, ancillary or non-acute care information for the patient than will fit on a single discharge record.

It is essential that continuation records be taken into account during data processing and analysis. The overflow accommodation, ancillary or non-acute care data generating the additional records is reported by uniquely populating only the accommodation, ancillary or non-acute care fields of each continuation record. The other information associated with the discharge is repeated on each of the required continuation records. This reporting format may lead data users to false conclusions. For example, each of three continuation records reported to SPARCS for a single discharge involving in-hospital death contains unique accommodation, ancillary and non-acute care information on each of the three records, but identical information for all other data fields. Ignoring the presence of multiple discharge records for this one patient discharge would contribute 3 discharges and 3 deaths to the hospital counts.

The full master file record format, Master (M), De-Identified Master (DM), will always require continuation record handling (as will any extract file containing accommodation, ancillary or non-acute care information) since these files will include multiple record discharges.

Continuation records can be properly associated with a discharge through the use of a Discharge Number, a Record Sequence Number, and a Record Sequence Count.

When multiple records are created, each record within the same discharge uses a common Discharge Number. All records having the same Discharge Number will have the same basic information repeated on every record. The records will differ only in the reported overflow accommodation, ancillary, or non-acute care data which caused the additional records to be generated. Every record within a common Discharge Number will also have a Record Sequence Number. The Record Sequence Number uniquely identifies records (1, 2, 3, etc.) within the total number of records (Record Sequence Count) associated with a particular discharge. For example, a discharge requires 3 records to report all the services provided during the hospitalization. All records in this 3 record discharge would have the same Discharge Number, unique to this discharge only. The Record Sequence Number for the second record in the set of three required records is set equal to "2". The Record Sequence Count on each of the three required records for this discharge is set equal to "3".

If no accommodation, ancillary or non-acute care information is needed, then only records with a Record Sequence Number value of "1" should be accessed.

The De-identified Abbreviated (DA) data file contains no accommodation, ancillary, or non-acute care information and therefore no multiple record discharges are possible. On the DA File, Discharge Number, Record Sequence Number and Record Sequence Count do not apply and consequently are not included on the discharge records.

See the following data element descriptions for additional information about specific fields:

Data Element 8 - Record Sequence Number
Data Element 9 - Record Sequence Count
Data Element 136-137 - Discharge Number Information Group
Data Element 60-64 - Accommodations Information Group Definition
Data Element 65-67 - Inpatient Ancillary Services Information Group Definition
Data Element 115-117 - Non-Acute Care Group Definition

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