BRR

Projects
Active?:	active
Program:	CC
Requestor:	unknown
Collection start:
Collection end:

BRR/XBR is an entry we use to identify whether patients are receiving therapeutic hypothermia (Targeted Temperature Management or TTM) following a cardiac arrest according to the Cardiac Arrest Cooling Protocol. By identifying all patients that receive this therapy a further audit can be done to identify if therapy was appropriate or not. We do not track cooling for reasons other than cardiac arrest.

Guidelines / Collection Instructions

For any ICU patient with one of the following diagnoses:

• Cardiac Arrest Witnessed 100-2
• Cardiac Arrest Unwitnessed 100-1

Do not code BRR or XBR when a cooling protocol is used to normalize temperature for any type of non-cardiac arrest patients.

Code in TMP follows:

• Project: Cooling
• item
  • BRR (BRR stands for "Brrrr" as in shivering or cold)
    • cooling protocol was applied at any point post arrest
  • XBR - no cooling protocol applied

Cross Checks

see Check BRR/XBR vs cardiac arrest dx

CCI

This will be coded as Whole body cooling in CCI.

We will need to

• import old tmp entries accordingly
• change cross checks to the new encoding method
• how do we ensure that all cardiac arrest patients either have TTM (targeted temperature management)or not if you use CCI? The correct term should be TTM. Hypothermia is not always needed. The idea is to keep the patient's temperature from going high. Usual maintenance temp is 36 degrees.

Background

Start Dates

• collection was started August 2004
• XBR and CCMDB.mdb cross checks were added to detect occasions where entry was just forgotten/missed March 19.09
• reviewed with Kendiss Olafson and Dean Bell.--TOstryzniuk 17:58, 26 August 2009 (CDT)
• cross-checks changed to include Unwitnessed Cardiac Arrest August 27.09
• moved from ICU Var 2 into TMP on Dec 18, 2014

Why the code XBR?

The rationale for the code XBR is to identify those patients who had a cardiac arrest but were not cooled regardless if they met criteria for cooling or not. XBR was implemented after an audit of cardiac arrest was done and it was found that there were several cardiac arrests coded that were missing code BRR. By leaving Variable 2 blank for a cardiac arrest, it is not clear to Kendiss or Julie whether a data collector missed tagging it or if indeed cooling was not applied. Coding XBR indicates to both Kendiss and Julie that a collector verfied that the cooling protocol was not applied.

removed 12 hr requirement

Discussed at task 2018-04-11: we are removing the 12 hr requirement because the use and application of the protocol has changed since inception and this restriction is no longer reasonable.

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