Task Team Meeting - Rolling Agenda and Minutes 2022
List of items to bring to task meeting
Add to this by adding the following to the article where the problem is documented:
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| wiki page | question | Last modified |
|---|---|---|
| wiki page | question | Last modified |
| Pneumonia, ventilator-associated (VAP) |
| 2024-11-13 9:30:51 PM |
Also see Task Team Meeting - Rolling Agenda and Minutes 2021
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ICU Database Task Group Meeting – March 9, 2022
- Present: Allan, Julie, Lisa, Tina, Pam, Pagasa, Barret, Pam, Stephanie, Mailah
- Minutes prepared by: AG
- Action items in BOLD
1. Update on new lab listings, which appear to duplicate prior listings. Nothing new to report.
2. Update on what Shared Health is planning with regards to the databases. Allan reported that as requested, he provided Perry with a document (from Tina) a technical description of what is needed. Awaiting more information from Perry.
3. Update on agreement to move to automated identification of the five APACHE II comorbid conditions. So, collectors will no longer be specifically identifying these once Julie/Tina implement this change. See also point (7)
4. Location metadata storage - Regarding creating new table containing information (metadata) about individual medicine wards (including High Obs). Tina/Julie to implement this, but Tina recently recognized that Cognos contains this information and before implementing it using info supplied by collectors, she has asked Chastity about obtaining it from Cognos instead.
5. Question from list: How to code if someone has a limb or organ removed during this stay but before they become our patient?
- Answer: We already have “past history of” codes for both these situations: Past history, loss of limb(s), Past history, removal of all or part of lung, Past history, removal of any part of digestive tract, Past history, removal of breast (mastectomy), Past history, removal of kidney (nephrectomy, partial or total), and Past history, removal of organ NOS
6. Question from list: Change to replace Accept DtTm with first Service tmp entry, and Arrive DtTm with first Boarding Loc
- We want to finally retire arrive time and accept time, replacing them with info from the Boarding Loc and Service temp. But Julie notes that we use these data to calculate and report on ER delays, and that in comparing the old with new way methods she has found some inconsistencies. So, before we completely make the changeover,
- At the next task meeting Julie will show us histograms comparing the two sets of data
- Lisa will look at the inconsistencies and see if she can figure out why it’s happening
7. Question from list Drug-induced immunosuppression.
- Tina made the point that the way we’re currently recording this entity for purposes of APACHE is as a TISS element, but that this is awkward and suboptimal.
- After discussion we agreed to instead collect this information under existing code Z92.25 Past history of immunosuppressive drugs or corticosteroids, and for that purpose Allan has changed the definition of that ICD-10 code, which is applicable to both ICU and wards. Lisa to notify collectors of this. Tina to update the created variables queries to reflect this.
8. Next Task meeting April 6 at 11 am
ICU Database Task Group Meeting – February 17, 2022
- Present: Allan, Julie, Sherry, Lisa, Tina, Pam, Pagasa, Mindy, Brynn, Barret
- Minutes prepared by: AG
- Action items in BOLD
1. Update on new lab listings, which appear to duplicate prior listings. Allan has begun working on this. Nothing new to report.
2. Update on what Shared Health is planning with regards to the databases. Allan reported that as requested, he provided Perry with a document (from Tina) a technical description of what is needed. Awaiting more information from Perry.
3. Change for Apache Chronic to ICD10 from separate variable - We agreed to move to automated identification of the five APACHE II comorbid conditions. So, collectors will no longer be specifically identifying these. Julie/Tina to implement this change.
4. Update on the approximately 200 database questions that have been assigned for assessment but not addressed.
- Tina reports this list is down to about 120 now.
- After discussion, we agreed to delay aggressively addressing these until our data collectors come back from their COVID assignments.
5. Location metadata storage - Update on creating new table containing information (metadata) about individual medicine wards (including High Obs). Tina/Julie to implement this. It will require that data collectors notify Julie and/or Tina and/or Pagasa when a specific ward is altered in such ways.
6. New questions:
- Agreed that instead of a new code for bronchospasm, that we’ll use the existing code of Wheezing
- Agreed to allow multiple listings of Past history, cancer (any type), believed cured to allow for people with multiple different past cancers. (Tina updated Query check ICD10 duplicates)
- Agreed that to code nontraumatic TE fistula to combine these 3 codes: Disorder of esophagus, NOS, Disorder of upper respiratory tract, infectious or noninfectious NOS, and the cause (e.g. cancer, abscess). ( created Template:ICD10 Guideline TE fistula and applied to those dx codes)
- Controlling Dx Type for ICD10 codes - Over the next 3 months Barret agreed to work through doing preliminary work to identify, for all the ICD10 codes we use, which are disallowed in the 3 existing bins (Comorbid Diagnosis, related to admission, occurred after admission) and Primary Admit Diagnosis. Tina has sent Allan and Barret the list.
7. Next meeting March 9 at 1pm.
ICU Database Task Group Meeting – February 3, 2022
- Present: Allan, Julie, Sherry, Lisa, Tina, Val, Pam, Pagasa, Mindy
- Minutes prepared by: AG
- Action items in BOLD
1. Update on new lab listings, which appear to duplicate prior listings. Allan has begun working on this. Nothing new to report.
2. Update on what Shared Health is planning with regards to the databases. Allan reported that as requested, he provided Perry with a document (from Tina) a technical description of what is needed. Awaiting more information from Perry.
3. Update on plan (4/15/2021 Task meeting) to implement automatic coding of APACHE comorbidities
- Allan is working on refining the ICD10 codes.
4. Further consideration of T19 - Spontaneous breathing via ETT without PEEP/CPAP, with or without supplemental O2 (TISS Item) and T20 - Supp O2 through any device, delivered via nose, mouth, ETT or trach (TISS Item).
- The original TISS28 item (CCM 24(1):64-73,1996) of supplemental ventilatory support, worth 2 points, is either of: (a) Breathing spontaneously via ETT without PEEP/CPAP, or (b) Supplemental O2 by any method without mechanical ventilation (invasive or noninvasive)
- So there’s some overlap here (which is OK since it’s a single TISS item) in that spontaneous breathing via ETT without PEEP/CPAP but with supplemental O2 fits into both ‘a’ and ‘b’
- On 6/15/2021 we changed TISS19 and TISS20 to:
- TISS19 = Spontaneous breathing via ETT without PEEP/CPAP, with or without supplemental O2 -- e.g. includes trach mask, T-tube
- TISS20 = Supplemental O2 though any device, delivered via nose, mouth, ETT or trach [which must be without invasive or noninvasive mechanical ventilation]
- However, at that time we incorrectly said that TISS19 is just 1 point, while in fact it should be 2 points (and TISS20 is 2 points also)
- There is still overlap between these versions of TISS19 and TISS20, specifically: breathing via ETT with O2 but without PEEP/CPAP fits both -- but this is not a problem, as when one computes the TISS score for a given domain (e.g. respiratory support), only the single item with the highest point score is counted.
- Allan suggests that we:
- Clarify TISS20: Supplemental O2 though any device, delivered via nose, mouth, ETT or trach, without invasive or noninvasive mechanical ventilation
- Modify TISS19: Spontaneous breathing via ETT without PEEP/CPAP, with or without supplemental O2, without invasive or noninvasive mechanical ventilation
- Ensure that TISS19 and TISS20 both are 2 points
5. Update on the approximately 200 questions that have been flagged for assessment but not addressed.
- Lisa dealt with approximately 40 of these, and referred approximately 70 of them to Julie and Pagasa.
- The remainder were either assigned to others, or unassigned. Lisa will categorize them into into 3 groups: Need to be addressed; Can be deleted from further consideration; Unclear.
6. A clarification was made in the Wiki regarding Medical Assistance In Dying (Z51.81). Specifically that it should not be coded in a record if the patient was transferred to a different institution to undergo MAID -- instead it should be coded at that other institution.
7. It was agreed to stop the manual notation made in the Boarding Loc comment field for COVID patients or those on COVID wards.
8. Clarification of coding for iatrogenic pneumothorax.
- The issue was that in coding iatrogenic PTX, the instructions are to combine: Iatrogenic, puncture or laceration, related to a procedure or surgery NOS along with one of the nontraumatic PTX codes. BUT all of the latter indicated not to use them for iatrogenic or traumatic causes --- and this was WRONG. The relevant Wiki pages have now been changed to say not to use them for traumatic pneumothorax, but that can be used for iatrogenic PTX.
- Allan's edit duplicated some info shown on those pages and standardized in Template:ICD10 Guideline Iatrogenic Pneumothorax. I tried to clear it up but it would be good if someone else could confirm that it now is not duplicated and makes sense. Ttenbergen 20:11, 2022 February 8 (CST)
9. After extensive discussion it was agreed to create a new table containing information (metadata) about individual medicine wards (including High Obs). This additional layer will be used to keep track over time of: bed count, ward type (specifically general ward vs. high obs) and other information. We recognize this will increase the work that Julie has to do for reporting on unit-specific information, but it provides flexibility for future. See Location metadata storage for further info. Tina/Julie to implement this. It will require that data collectors notify Julie and/or Tina and/or Pagasa when a specific ward is altered in such ways.
10. An example was raised that a patient went medicine ward --> endoscopy --> OR --> surgery ward; but there was no appropriate Dispo location from the medicine ward. After discussion, we agreed to add to Dispo locations for each hospital a listing such as: HSC, Procedure location, NOS. Tina to implement this; this is also mentioned at Medical_Assistance_In_Dying#Collection_Instructions_for_MAID so any update needs to fix that as well..
ICU Database Task Group Meeting – January 6, 2022
- Present: Allan, Julie, Sherry, Lisa, Stephanie, Tina, Val, Pam, Mailah, Mindy
- Minutes prepared by: AG
- Action items in BOLD
1. Update on new lab listings, which appear to duplicate prior listings. Allan has begun working on this. Nothing new to report.
2. Update on what Shared Health is planning with regards to the databases. Allan reported that as requested, he provided Perry with a document (from Tina) a technical description of what is needed. Awaiting more information from Perry.
3. Update on plan (4/15/2021 Task meeting) to implement automatic coding of APACHE comorbidities. Allan is working on refining the ICD10 codes.
4. Update on the decision from 11/30/2021 meeting to revert to the old system, of starting a new record (with new APACHE score and new admit diagnoses) with service changes. This has been done, with relevant changes to the Wiki and “unwinding” of the 10 records that contain such MICU to SICU or SICU to MICU transfers into separate records.
5. Allan reported that he is working on drafting a Data Sharing Agreement that all users of line-level (i.e. individual record) data will need to complete to obtain such data. Draft version is in Database_Request_Process#Data_Accessibility_and_Responsibility. Work is ongoing on this. Also, a decision will need to be made about whether we need a similar agreement for users of cumulative/aggregate data.
6. Discussion about the Minimal Data Set and reporting. We agreed:
- We will retain the 11 elements of the “true” minimal dataset, all of which come from Cognos.
- Going forwards, all reporting by Julie will consist of details only from completed records, along with information about what % and # of records for the time interval are incomplete as of the time of the reporting.
- Lisa will let all collectors know of this change
- Tina has updated Minimal Data Set regarding it
- Allan will let Bojan know -- done.
7. There is a new ICD10 code U07.5 Past history of Covid-19 infection which is meant to be used just like the other “Past history of…” codes. Lisa to let all collectors know about it.
8. After discussion we agreed that there is no further need for the Wiki page "HSC Boarding Locations". Tina has deleted it.
9. The question was raised about definition of Emergency Surgery (concept). After discussion we agreed to maintain it as is, i.e. admitted from Operating Room or Recovery AND surgery was classified as E1. Tina has updated wiki Emergency Surgery (concept), Emergency Surgery (TISS Item) and Admit Type for APACHE II to make sure this is defined consistently.
10. There is confusion about TISS elements T19 - Spontaneous breathing via ETT without PEEP/CPAP, with or without supplemental O2 (TISS Item) and T20 - Supp O2 through any device, delivered via nose, mouth, ETT or trach (TISS Item) .
- This issue tracks back to the 6/15/2021 and 7/8/2021 minutes where indeed the current versions of TISS#19 and TISS#20 were chosen, both as 2 points, in order to correlate correctly to the original/actual delineation of TISS. So, no changes needed for these.
11. Tina identified that there are approximately 200 database questions that have been assigned for assessment but not addressed. Lisa will go over this list and categorize them into 3 groups: Need to be addressed; Can be deleted from further consideration; Unclear. We’ll discuss this further next meeting.
12. Next meeting February 3, 2022 at 11 am.
2021...
Also see Task Team Meeting - Rolling Agenda and Minutes 2021