Query check CCI TISS discontinuous ETT

Data Integrity Checks
Summary:	T22 - ETT Present (TISS Item) should start with an T40 - Insertion of ETT (TISS Item) and end with an T28 - Planned extubation (TISS Item) or T29 - Unplanned extubation (TISS Item).
Related:	Insertion of ETT (TISS Item), Planned extubation (TISS Item), Unplanned extubation (TISS Item)
Firmness:	soft check
Timing:	complete
App:	CCMDB.accdb
Coding:	query check_CCI_TISS_discontinuous_ETT
Uses L Problem table:	not relevant for this app
Status:	ready to implement
Implementation Date:	2021-11-10
Backlogged:	No

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This query checks for some scenarios around intubation that are possible, but are entered erroneously often enough to make it worth warning about them. It is implemented as a soft check, so collectors can click past it.

Could happen in case of Tracheostomy creation in procedure suite

There might be no extubation if pt has a trach (T23 - Trach Tube Present (TISS Item)) created (Tracheostomy creation), since that would be done in OR and part of it would be the extubation. Since this would be a soft check, the collector could just OK past it if this is the case.

The check

intubation or extubation

• T28 - Planned extubation (TISS Item)
• T29 - Unplanned extubation (TISS Item)
• T40 - Insertion of ETT (TISS Item)

ETT or ventilation

• T22 - ETT Present (TISS Item)
• T18 - Invasive Mechanical Ventilation (TISS Item)

conditions

• if previous date has no T22 - ETT Present (TISS Item) and today date has T22 - ETT Present (TISS Item) then T40 - Insertion of ETT (TISS Item) should be marked
  • Error: No ETT_1, Has ETT_2, No intubation_2

• if previous date has T22 - ETT Present (TISS Item) and today date has no T22 - ETT Present (TISS Item) then previous date of the T29 - Unplanned extubation (TISS Item) or T28 - Planned extubation (TISS Item) should be entered
  • Error: ETT_2, No ETT_3, no extub_2

• if previous date has T22 - ETT Present (TISS Item) and today date has T22 - ETT Present (TISS Item) and T40 - Insertion of ETT (TISS Item) are marked then today date of T29 - Unplanned extubation (TISS Item) or T28 - Planned extubation (TISS Item) should be marked
  • Error: ETT_2, ETT_3, intub_3, no extub_2, no extub_3
  • Error: ETT_2, ETT_3, extub_2, no intub_2, no intub_3

remaining questions

• T28 - Planned extubation (TISS Item) or T29 - Unplanned extubation (TISS Item) can only be marked when both
  • 1) T40 - Insertion of ETT (TISS Item) is marked on same day and
  • 2) T22 - ETT Present (TISS Item) is marked in previous day.
• the sequence is being intub yesterday and the next day extub then new insertion on same day.

Most intubated patients eventually get extubated without getting intubated again; this check would flag every one of them! Is that actually what you want, or am I misunderstanding this one?

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• T28 - Planned extubation (TISS Item) or T29 - Unplanned extubation (TISS Item) can only be marked when both
  • 1) T40 - Insertion of ETT (TISS Item) is marked on same day and
  • 2) T22 - ETT Present (TISS Item) is not marked the next day.
• the sequence is today new insertion then extub and tomorrow has no tube.

I don't even understand when this check would ever make sense... what do you mean with this one?

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Log

• 2021-11-10 - implemented query but not calling it from code yet, want Lisa or someone to check on this