Team Meeting June 12 2008

A team meeting has been scheduled.

Time: 12 June 2008, 11:00 - 13:00

Location: HSC, 4th floor of the John Buhler building, room 405

Please make every effort to attend this meeting if at all possible. Medicine data collectors please bring examples of where you are getting your information to complete the Katz ADL from.

Agenda

• Discuss how the MOST Score is being collected - Trish or Linda
• What the MOST Score is used for - Dr. Roberts
• Discuss discharges to ER – Julie
• Review Vital Signs project – Julie
• Review the Wiki application – Tina
• Questions and Answers - Everyone

Tina will be updating the Wiki with the answers to your questions.

If you have any other questions or concerns please send them to Linda ahead of time so we can ensure questions get addressed.

Questions/Concerns Submitted so far

1. Clarify definition for Hypotension NYD- it says not due to shock or post-op in the code book we don't know when to use this. Why can't we just have hypotension NYD for a code? In other words if patients don't meet the specific criteria for septic shock or hypovolemic shock or cardiogenic shock it would be NYD.
2. Clarify definition Septic Shock
3. Clarify definition Cardiogenic Shock
4. Clarify definition Cardiac Arrests-It's impossible to see how many occur right before admission to Medicine as some patients are admitted to medicine bypassing ICU
5. Clarify definition Violent behavior code - supposed to be 2nd to dementia but is used for anyone who is violent
6. Clarify definition Panelling or Discharge Planning why does it say in the code book primary reason for admission to ward bed?
7. Clarify definition
   • Muscle deconditioning
   • Pain Control - non post op
   • Pain Control - post op - we feel it is highly overused
8. Clarify definition Palliative Care - need criteria to follow
9. Acute coronary insufficiency and Unstable angina (151, 152) - description in code book should be reversed
10. There currently is no codes for: hematuria- we have lots of people who are getting CBI for hematuria NYD
    • either add to Category:Diagnoses we are not coding or make Hematuria NYD
11. Regarding the KATZ ADL
    1. assessment for feeding; when a person arrives to the unit within the first 24 hours NPO either for a test or for GI Bleed does this qualify as Dependant? The KATZ says 'Dependant is assistance to eat; does not eat (I interpret this to include NPO); must be fed; fed partly or completely by NG or IV.
    2. Continence for assessment; does the use of a foley from home or within the first 24 hours qualify as Dependant. The KATZ states "Dependant as assistance; incontinent or cathether used (as with the use of a foley).
12. Will a position be created to focus on quality control through chart audits to ensure our data is consistent? It would be nice to have some feed back.
13. The Diagnostic coding book would benefit from a thorough "overhaul" to itemize specific criteria for coding definitions. As a group each month we could perform audits in each dx category with the goal of talking about codes etc in order to all understand when and where to use them. The Wiki may be the best way to do this.
14. Possible impacts of the new Code Blue policy at HSC

Meeting Notes

Dan: Discussed the MOST score. The MOST score is a equation derived from the Charlson Comorbid index, the Glascow Coma Score, the ADL, systolic BP, heart rate, respiratory rate, white blood cell count the sex of the patient and their age. With these variable the equation can predict the likelihood of the patient having an adverse outcome such as death, a cardiac arrest and readmission or admission to an ICU. This equation was validated based on data collected at HSC, SBGH, the Grace and Victoria hospital on over 11,000 patients admitted to medical units in 2004/2005. There is no existing tool that can make such prediction for non ICU patients. This makes this equation and the research conducted by Dr. Roberts and Julie extremely valuable and powerful. Because the MOST score can be used to predict negative outcomes the intention is to try and use it to prevent the. This required that the ongoing integrity of the data is consistent. This is why there was some concern when the 2008 data indicated a significant change in the MOST score values at HSC and SBGH. This promoted the need to review the data collection standards.

Trish: Dicussed how the MOST score elements as of December 2007 at which time some of the old vital sign data fields were removed and clear guidelines were provided for the collection of the ADL and the other MOST score elements.