Task Team Meeting - Rolling Agenda and Minutes 2020
List of items to bring to task meeting
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Also see Task Team Meeting - Rolling Agenda and Minutes 2019
ICU Database Task Group Meeting – December 11, 2019
- Present: Allan, Barret, Con, Joanna, Julie, Tina, Trish
- Absent:
- Minutes prepared by: AG
- Action items in BOLD
1. Followup about working to reduce collector workload
- Regarding obtaining CBS TraceLine for all transfusion data. Allan will follow up with Margaret Ring (margaret.ring@blood.ca) and Tony Loewen (anthony.loewen@blood.ca)
- Regarding obtaining RIS data for radiology tests. Allan will follow up with RIS administrators (Angela Charbonneau 926-9874; Randy Roels 926-9871, rroels@sharedhealth.mb.ca).
- Regarding obtaining automated ABG data at HSC and St. B:
- Julie reported on direct comparison of ABG/VBG data from DSM vs. our collectors. Identification of individuals who got blood gases was 84% for VBG and 95% for ABG. Identification of the number of test was 82% for VBG and 92% for ABG. We agreed to move ahead now with obtaining these data (again, just for HSC and St. B; we will still get these data manually at Grace) from DSM.
- Regarding consolidating some of the “what was done” components of CCI therapeutic interventions:
- Tina has combined "Excision, Resection, partial", Excision, Resection, total and Excision, Resection, radical into a single item CCI “what was done” items which we’ll call Excision, Resection and give it the existing code of ‘87’. Tina has instructed Pagasa on how to collapse these items.
2. Followup on having the ICU nurses do all TISS coding --
- We have top administrator agreement at HSC. Dan is working on getting similar meetings at St. B and Grace. Goal is to get their agreement and to then:
- Begin having the nurses routinely and uniformly start doing all TISS sheets 1/1/2020.
- For a couple of weeks to do audit by also having our data collectors do their own, separate TISS scoring ---> have Julie compare results ---> If adequate (>90% or so), then cease having our collectors do TISS, BUT to repeat such fidelity testing about 1 week every 6-12 months, indefinitely; see 2020 TISS audit
3. Followup on trying to get hospital-level data elements from EPR. Tina discovered that there is an application called Cognos which has capability to extract data elements from existing databases.
- Allan left a message with Phil Jarman (926-8036) to pursue this further.
- Tina has opened incident 3845870 and is working with Alex Omsen and Mike Ocko on getting this setup; see Cognos#Phone call with Mike Ocko
4. Follow up on how to code -- Allan will explore these:
- Compartment syndrome other than abdominal -- it turns out that this is already included and explained in Muscle, ischemic infarction
- Mesenteric vacular injuries
- We already have a code Abdomen or pelvic, blood vessels NOS, injury/trauma that includes all traumatic versions of injuries to any of these vessels
- Iatrogenic injuries to these vessels fall under Iatrogenic, puncture or laceration, related to a procedure or surgery NOS
- Diagnostic sampling of pericardial fluid or the pericardium -- to be discussed further at next Task meeting
- for therapeutic pericardial drainage combine (T) Pericardium with Drainage, Evacuation
- for diagnostic pericardiocentesis -- we currently do not have the components to create this item. We could add it as a picklist item, and indeed have a couple of choices:
- we could call it "Diagnostic pericardiocentesis" with code 2.HA.52
- or we could include both diagnostic fluid drainage AND diagnostic pericardial biopsy together, calling it "Diagnostic pericardial sampling (fluid or tissue)" with code 2.HA.13.
5. New issue of pulling in certain lab results as well as current counts.
- The plan is to re-parse all DSM data from 1/1/2019, and to use this opportunity to pull in time/dates and results for specified tests.
- Barret with help from Tina will generate a draft list of which tests to do this for, which we’ll discuss at the next Task meeting. It should include the tests needed to calculate APACHE 2. Care must be taken to balance usefulness with data storage issues.
- As part of this, we will work so that the labs values that are part of APACHE 2 no longer need to be dealt with by the data collectors.
6. Item we didn't discuss yet -- unconfirmed diagnoses with priority 0. We'll discuss next time.
7. New items:
- Barret raised the issue of CPEs = carbapenemase producing enterobacteraciae, and more generally the rising rate of carbapenem resistant bacteria. He suggested that in the list of resistant bacteria, we split out carapenem resistance as a separate category. Allan spoke to micro lab and ID personnel who also suggested tracking these separately. Thus a new code has been added Resistance to carbapenem antibiotics. Previously this was included in 82.8 Resistance to antimicrobials, antibiotic, resistance to other beta lactams; Allan has changed that Wiki page to remove it from there.
- Allan will seek out how to code so-called autotransplantation of kidney --- turns out this is included in CCI, as 1.PC.83 which is "transfer" of kidney. We don't currently include "transfer" among the list of "what was done". So since this is a very rare procedure, to code it we should use 1.PC.94, i.e. combine therapeutic intervention on kidney with the what was done category of "NOS" (94).
- Request for a code for bronchopleural fistula -- it turns out we had already decided on this, using the appropriate one of: Pneumothorax, traumatic OR Pneumothorax, tension, nontraumatic OR Pneumothorax, nontension, nontraumatic OR Pneumothorax, nontraumatic, NOS
- IF, as is usually the case when these fistulas are spontaneous (rather than caused iatrogenically or by trauma), it is due to lung infection or abscess, then that code should also be combined with the appropriate one of these. And in this case also code Empyema (pyothorax) if present, combining it with the others.
- Query about coding for the myraid of other fistulas out there -- Allan identified that there are separate codes for all of these when nontraumatic (J95.03 for T-E, K31.6 for stomach or duodenum, K60 for anorectal,, K63.2 for intestinal, K82.3 for gallbladder, M25.1 for joint, N32.2 for bladder, N82 for female genital tract, and other for less common ones (e.g. lacrimal duct)). What we have to decide is whether to include some or all of these additional codes, or just to code them in the appropriate "NOS" category. We'll discuss this at the next Task meeting.
- Question was asked of how to code chronic subdural hematoma. It turns out that we previously dealt with this question at an earlier task meeting. ANSWER was that we already have I62 Subdural or epidural hematoma/hemorrhage, nontraumatic and that unless/until somebody specifically wants to distinguish these two related entities for a specific question/project, we will not subdivide them. Allan has added a note to that Wiki page saying so.
- Question was asked of whether/how to code a flail chest resulting after rib fractures from CPR.
- This is related to a prior question of how to code Rib fracture(s) due to CPR. We also already have a code for traumatic flail chest, i.e. Flail chest, injury/trauma. Given our general rule of NOT using trauma codes for iatrogenic injuries, Allan proposes here that when a flail chest occurs after CPR (which is rare) that we simply use Rib fracture(s) due to CPR. He has added this to the relevant Wiki pages.
Next meeting 1/2/2020 at 11am.