Team Meeting June 12 2008: Difference between revisions

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==Meeting Notes==

Dr. Roberts:

Discussed the MOST score. The MOST score is a risk stratification ~~toll~~ that generates a probability of an adverse outcome for a patient. The equation is 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.

Discussed the MOST score. The MOST score is a risk stratification tool that generates a probability of an adverse outcome for a patient. The equation is 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 them. ~~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.

Because the MOST score can be used to predict negative outcomes the intention is to try and use it to prevent them. As we continue to monitor the MOST score and consider how to apply it as a intervention tool it is critical 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:

Discussed how the MOST score elements were to be collected 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. This information can be found by clicking on this link.

Trish clarified that it is not supposed to be the worst assessment values observed prior to a patient being admitted to a ward rather the value ~~closed~~ to the decision to admit. If there were no ~~pre~~ admissions ~~scores documented~~ then it should be the closed score post admission. If no assessment value was recored withing 48 hours pre admission or 48 hours post than the data collector should assume normal.

Trish clarified that it is not supposed to be the worst assessment values observed prior to a patient being admitted to a ward rather the value closest to the decision to admit. If there were no score documented 48 hours prior to admissions then it should be the closed score post admission. If no assessment value was recored withing 48 hours pre admission or 48 hours post than the data collector should assume normal.

Dr. Roberts:

Asked each hospitals Medicine data collectors to report on how they were collecting the ADLs now and at the time of the initial MOST score study:

Grace-Have always done it the same way. Try if possible to derive the ADL from the ER notes but the majority of the time it is taken from nursing notes within 24 hour of the patients admission.

Questions to Dr. Roberts:

If a patient is sedated what should their GCS be. It should be based on there non sedated state not chemically altered.

If a patient had a stroke and can't talk but can communicate the verbal score should be 15.

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 ==Meeting Notes==
 Dr. Roberts:
-Discussed the MOST score. The MOST score is a risk stratification toll that generates a probability of an adverse outcome for a patient. The equation is 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.
+Discussed the MOST score. The MOST score is a risk stratification tool that generates a probability of an adverse outcome for a patient. The equation is 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 them. 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.
+Because the MOST score can be used to predict negative outcomes the intention is to try and use it to prevent them. As we continue to monitor the MOST score and consider how to apply it as a intervention tool it is critical 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:
 Discussed how the MOST score elements were to be collected 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. This information can be found by clicking on this link.
-Trish clarified that it is not supposed to be the worst assessment values observed prior to a patient being admitted to a ward rather the value closed to the decision to admit. If there were no pre admissions scores documented then it should be the closed score post admission.  If no assessment value was recored withing 48 hours pre admission or 48 hours post than the data collector should assume normal.
+Trish clarified that it is not supposed to be the worst assessment values observed prior to a patient being admitted to a ward rather the value closest to the decision to admit. If there were no score documented 48 hours prior to admissions then it should be the closed score post admission.  If no assessment value was recored withing 48 hours pre admission or 48 hours post than the data collector should assume normal.
 Dr. Roberts:
+Asked each hospitals Medicine data collectors to report on how they were collecting the ADLs now and at the time of the initial MOST score study:
+Grace-Have always done it the same way. Try if possible to derive the ADL from the ER notes but the majority of the time it is taken from nursing notes within 24 hour of the patients admission.
+Questions to Dr. Roberts:
+If a patient is sedated what should their GCS be. It should be based on there non sedated state not chemically altered.
+If a patient had a stroke and can't talk but can communicate the verbal score should be 15.
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