Selection and timing of APACHE components

This page explains how to select physiological or GCS values for entry into the fields used for Apache in CCMDB.accdb.

APACHE ALERT Scale timing of assessment uses slightly different definition, but it is closer than it used to be now that we start Apache at accept rather than arrive. Can we combine? Ttenbergen 14:26, 2020 December 23 (CST)

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Instructions

Choose the worst value that occurs within the 24 hours after Accept DtTm.

This page is just a place holder for now, I am currently consolidating this info here. Ttenbergen 14:09, 2020 December 23 (CST)

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Moved here from Change to start collection at accept rather than arrive time needs integration: The APACHE elements time frame will start in the off-ward bed location.

Does it really start in ER? since that's now one off-ward location? In any case, we should really only link to the definition in APACHE from here so this doesn't become inconsistent. If someone knows where that's documented, can you please confirm and fix? Ttenbergen 00:36, 2020 October 16 (CDT) I haven't been able to find it on the Wiki, but I was told to get my values for my Apache from the previous location. So for example a patient getting admitted to the ward from ER, the Apache values would be the ones just prior to their Accept Dt/Tm. Think "this was their condition when they were accepted by medicine". If it's a transfer to the ward from ICU, I take the last values before they left. Surbanski 11:14, 2020 October 19 (CDT) To confirm for patients admitted from ER, Apache vital signs are taken from closest to but prior to Accept Date/time? For medicine yes. I don't know if ICU does anything different. If I've been doing it wrong I expect someone from medicine at the other sites will say something :) Surbanski 10:31, 2020 October 20 (CDT) Dose ICU start there APACHE and TISS from the ER accept time or ICU admit time. Currently we collect from the ER accept time only when the patient is boarded in the ER for greater than 2 hours. Gthomson2 10:43, 2020 October 20 (CDT) Since Oct.15th, I have been using the 24 hour period after the accept time, which means that I am including the applicable Vitals from ER if the patient was from the ER. I wasn't at the task meeting yesterday, so I don't know if this was discussed, but this was my understanding of how we are supposed to collect apacheMlagadi 11:02, 2020 October 23 (CDT)

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From APACHE physiological variable collection, needs integrating: Select the physiological values that reflect the worst deviation from normal in the first 24 hours while "in" the ICU. The clock starts at the Arrive DtTm . If the length of stay in ICU is less than 24, use those values only.

We decided that a record starts at service acceptance, not unit arrival. This was partly to change the strange exception of EMIPs. So should this still be "in ICU" or should it now be "on ICU service"? Ttenbergen 13:31, 2020 November 25 (CST)

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We use different instructions for Medicine: ALERT Scale timing of assessment - can and should those be unified? Ttenbergen 13:34, 2020 November 25 (CST)

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The Worst value could be high or low, depending which gives the most points. Keep in mind the diagnosis and try not to include iatrogenically modified values, e.g. BP severely high due to inotropes or decreased LOC due to sedation.

Exceptionally high or low values

CCMDB.accdb has error checks for values that are unlikely high or low to prevent errors. The ranges were determined by the statistician based on previous data(see abs min and abs max in APACHE_Scoring_table). To keep the checks meaningful the threshold values will not be changed for extreme outliers.

For values outside the "warning" limit, you must enter the reason for this into the Notes field so that we can validate that these were not errors.

For values outside the "absolut" limit, enter the closest value allowed and enter a comment into the Notes field. Also, email Pagasa the correct value.