JALT Meeting - Rolling Agenda and Minutes 2022

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List of items to bring to JALT meeting

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Check pre acute consistent JALT
  • Julie found data discrepancies and asked if we could review doing cross checks at least on records with the same Visit Admit DtTm for the following fields:
  • We reviewed a broader cross check proposal (link below) in some detail in a version available in the history of this page], so if we consider adding this we should confirm that none of those apply to any checks. Or we can ignore and just implement as soft-checks. Thoughts? Ttenbergen 12:28, 17 December 2025 (CST)
 2025-12-17 6:30:28 PM
Chronic Health Facility
  • Discussed this at JALT Meeting - Rolling Agenda and Minutes 2025#JALT 2025-03-11 but I don't remember if we came to an answer or next step. Just found a note to add that we will also need to decide if any of these are in-patient locations. This would make them collectable as Pre-admit Inpatient Institution, and is relevant as per Pre-admit Inpatient Institution field#Data Use / Purpose.
  • are you referring to PCH's because they are not inpt locations or are you referring to chronic health facilities? Lisa Kaita 14:52, 25 June 2025 (CDT)
    		•  2025-11-28 1:43:16 PM
    Chronic Health Facility
  • This issue raised a problem with medicine data recently, and we will review again if this needs to be coded more granular after all,
  • dicussed at JALT June 25, 2025: while Bojan would like this it is not possible to keep track of unit changes and not always easy to tell which unit they arrive from so leave a Riverview and Deer Lodge (DLC), with the exception of the PCH units in each facility.Lisa Kaita 14:52, 25 June 2025 (CDT)
    		•  2025-11-28 1:43:16 PM
    Chronic Health Facility We have discussed lately that we might want to become more nuanced about some chronic care locations (Deer Lodge (DLC) and Riverview). I have removed the details from the above linked fields and consolidated here. Once this page is cleaned up this discussion entry can be removed.
  • Discussed at
    		• 2025-11-28 1:43:16 PM
    Data Processor Portal JALT
  • We need a plan for how this gets done when Pagasa is away. Ttenbergen 12:29, 6 January 2026 (CST)
    		•  2026-01-06 6:31:16 PM
    Definition of a Medicine Program Admission JALT
  • heard that some beds at STB may have been "given" to Nephro, so we may be collecting them? Made me do a quick query to get rough numbers, sent off to JALT. . Is there anything we want to update in our definition based on this?Ttenbergen 18:55, 8 December 2025 (CST)
    		•  2025-12-09 12:55:39 AM
    Discharged to community JALT

    Just a placeholder for now because the idea of how we define dispo to community (or for that matter, re-admit Previous Location) in data came up re. things like Readmission to MedWard and others. We have the obvious "Home" but if someone is discharged to something like Dialysis, would that also count? How do we define? Ideally by a column in s_dispo table such as s_dispo.loc_type, but that one uses "non-patient" which it also uses for Deceased patients (should we just split that out?). There is probably even more to this. Likely Julie has more than one approach in reporting. This came up because we were looking to define this for LAU collection readmission data.

    • This is actually just as much regarding to admitted from community, so maybe this should just be renamed to "outpatient sites in s_dispo table"?
    		 2026-01-22 3:40:32 AM
    Dispo field JALT

    I thought we had decided at JALT to collect this as presented by EPR... do I remember this wrong? I had already added it in CCMDB.accdb Change Log 2025#2025-03-11-1. Ttenbergen 22:52, 11 March 2025 (CDT)

    • Yes, I saw that, come to think of it I don't think we decided, not in my notes, but we can use it and I will change the wiki instructions Lisa Kaita 11:25, 13 March 2025 (CDT)
    • If we are going to collect this detail for dispo, should we consider whether or not to also look at SH in preadmit living situation?, currently lumped with community facility with support. Lisa Kaita 14:45, 16 April 2025 (CDT)
    • The entry name includes "TRSF" - is the entry for the previous location equivalent in EPR? Ttenbergen 23:30, 16 April 2025 (CDT)
    • no because the previous location would usually be <site>_ER Lisa Kaita 09:53, 28 May 2025 (CDT)
      • Sorry, I should have asked about "pre-hospital location in ADT". Ttenbergen 16:21, 28 May 2025 (CDT)
    		 2026-01-27 5:10:08 PM
    Intended1stSrvc JALT
  • 2025-12-18 JALT - We may want to discuss the discrepancy of our naming and its implications with the recipients of our reports and possibly the team that reports similar out of EPR. Ttenbergen 14:44, 23 December 2025 (CST)
    		•  2026-01-29 4:54:48 PM
    Intended1stSrvc JALT
  • Can these entries only be at the same site as the record (eg would "Gra ICU" be a legit entry for a patient at HSC MICU)? If only same siet that may be a relevant cross-check.
    		•  2026-01-29 4:54:48 PM
    Patients residing in Manitoba with ambiguous MH Health coverage JALT
  • The page name isn't quite right, this concept is still evolving in documentation.
  • Some of these may be better off broken out as their own pages or templates and only indexed from here.
    		•  2025-08-14 5:06:29 PM
    Project NonTradLoc JALT
  • preliminary data review
    		•  2026-01-13 8:28:31 PM
    Project Overstay2
  • We have had patients admitted from the chronic care unit at DLC (they live there) the nurses check off PCH for where they reside (on DPST), for Pre acute living situation field we enter Chronic Health Facility and for dispo we enter Deer Lodge, should we be considering this a PCH? as per instructions on DPST they do not continue the DPST form Lisa Kaita 12:35, 24 November 2025 (CST)
  • yes that answers my question, for the most part we can figure it out through the notes, lets leave collection as is. If you are ok with this lets take it off the JALT list Lisa Kaita 09:06, 17 December 2025 (CST)
  • Agreed it doesn't need to be on JALT. I will keep it around as a comment because it's part of the whole Chronic Health Facility issue. Ttenbergen 11:44, 17 December 2025 (CST)
    		•  2025-12-17 5:44:01 PM
    Query check tmp AHC JALT
  • if there is referral sent there must be a referral received entry and a consult dealt with entry Lisa Kaita 11:31, 7 August 2025 (CDT)
    • pt could die in between? consult could go missing? In a way those would be really the ones we would want to know about, no? I suppose we could make it a soft check... Ttenbergen 16:26, 19 August 2025 (CDT)
    • this almost sounds like the opposite of how I would have understood the current instructions. I would have thought those to mean to only enter "consult received" if there was no good data for consult sent. How do we actually want to use this?
      • late answer: how did Julie analyze this? at the time all fields were mandatory, unless there was no consult, current status, collect consult sent and if no data found for this then use consult received. Lisa Kaita 12:59, 13 January 2026 (CST)
      • I don't know, flagging for Julie and putting this on the JALT agenda; collection is still going, so we may still want to implement this. Ttenbergen 14:58, 13 January 2026 (CST)
    		•  2026-01-13 8:58:25 PM
    Selkirk Mental Health Centre JALT - Mental Health Facilities in Addition to Selkirk
  • Should we add Eden Mental Health Centre as well? Are there others, like addiction treatment facilities (eg Bruce Oake), that we should code either as a group or individually?
    • If we don't think this information is needed, should we also de-list our entry for Selkirk for consistency? Another option is to rename the selkirk entry and use it as an aggregate location going fwd.
    		•  2025-12-17 6:03:11 PM
    Selkirk Mental Health Centre JALT - Mental Health Facility Coding vs PCH
  • currently aggregated as "PCH" because S dispo.loc type is PCH. That seems wrong. Should it be changed to “unknown/other” or to a new category “Mental Health”? And should we add Eden Mental Health Centre as well? Ttenbergen 16:21, 29 October 2025 (CDT)
    • Julie reviewed, only 6 cases in our data (are we coding this consistently?). Julie emailed OK with “unknown/other”, but also raised how Pre acute living situation should be coded.
    		•  2025-12-17 6:03:11 PM
    Sending Patients JALT
  • Can we again revisit the pros and cons of sending only when working on site against sending from home? There is always a need of updated data and I do not want to be emailing everyone to send when data are needed. This can be solved by sending in all days the collector works regardless onsite or from home during the assigned time slots. In addition, I think this practice of submitting data frequently will also mean lesser new data on the laptop if unfortunate incident happens on the laptop and there is a need to re-enter data again. Do we still experience problem in sending when we set up the sending time schedule by site? --JMojica 16:37, 2 December 2025 (CST)
    • There might be ways to make sending faster or more reliable. This would take a fair bit of analysis and testing.
    One reason I have not pursued this is the prospect of re-platforming. A cloud based system would eliminate sending; it might cause new process tangles but that's a different topic. So it would be good to have an idea of the time horizon for this to decide if the work to mitigate the errors and reduce sending restrictions is worth it.
    It might be possible to find a compromise that re-balances risk and benefit. Ttenbergen 01:19, 3 December 2025 (CST)
    • I heard nothing from the collectors about errors in sending since we started this new schedule. If they work from home, can we allow them to send? They can send early or after 04:30 PM. PTorres 14:27, 3 December 2025 (CST)
      • Open to it. If things work fine now, changing process may break them again. Ttenbergen 11:50, 17 December 2025 (CST)
    		 2025-12-17 5:50:08 PM
    Service tmp post-send consistency checks
  • As discussed at JALT Meeting - Rolling Agenda and Minutes 2025#JALT 2025-11-27: Do we need any post-send, cross-record checks relating to Service tmp entry? Ttenbergen 16:44, 27 November 2025 (CST)
    		•  2025-11-27 10:44:27 PM
    Service/Location field
  • 2025-12-18 JALT - the notes about 2025-05 Revision of concept around ICUotherService / Intended1stSrvc also talked about Service/Location being made consistent with Boarding Loc; did we decide to proceed with this? The change to s_dispo table would be easy, but it would also apply to eg Previous Location, and any cross-checks or report using string literals to match would be affected, so testing the impact would be harder. Ttenbergen 02:42, 24 December 2025 (CST)
    		•  2025-12-24 8:46:05 AM
    Standard data cleaning process
  • While discussing Visit Admit DtTm differences within same admission at JALT Meeting - Rolling Agenda and Minutes 2025#JALT 2025-03-11 I realized we don't have any part of your "cleaning" process documented. We should, even if it is a rudimentary notice of the SAS files you use and what you check for. Ttenbergen 21:51, 11 March 2025 (CDT)
  • If there is linking beyond Populate linking pairs, or if you use a different linkage, we need to document that as well; do you? Ttenbergen 21:51, 11 March 2025 (CDT)
    		•  2025-03-12 2:51:43 AM
    STB Medicine Collection Guide There was a discussion about the beds that had been "handed to" them... what was the outcome, should it go here?
  • still discussing at JALT AG will speak with nephro and NH about what to do going forward Lisa Kaita 10:43, 6 January 2026 (CST)
    		•  2026-01-06 4:43:51 PM

    _

    _

    JALT Meeting – November 16, 2022

    • Present: Julie, Allan, Lisa, Tina
    • Emails: LKaita@hsc.mb.ca; allan.garland@umanitoba.ca; JMojica@hsc.mb.ca;TTENBERGEN@hsc.mb.ca
    • Minutes prepared by: AG
    • Action items in BOLD

    1. About APACHE 2 Scoring -- i.e. 2019 to 2022 there was an approximate 5 point rise in mean APACHE 2 scores limited to Grace Hospital (pre=Aug2019-Aug 2020 vs. post=Aug 2021-Aug 2022).

    • Julie analyzed the individual APACHE elements from "pre" to "post" and found:
      • All APS elements worsened by about 5.4 points total. The neuro subscore being about half of this worsening, with all 3 GCS elements worsening similarly
      • The age points FELL by 0.27 -- indicating a fall from pre to post of a few years in age of the average patient
      • Virtually no change in chronic health points
    • THUS, from pre to post time periods it seems that the Grace ICU patients got: a bit younger but sicker. This could be consistent with more COVID patients being admitted there. In any case, this change appears real, i.e. not due to any artifact or change in coding of any single (or few) APACHE elements.
    • Allan let Barret, Heather and Roseanne know these findings.
    • We did seem to identify to possible problems with the automated code used to calculate APACHE subscores and total score, which Julie and Tina will check out:
      • When Allan summed the APS elements he got a slightly different mean value from the automatically calculated version
      • There are 2 apparently contradictory chronic health fields that need to be understood and adjusted if necessary, they are called "ApTotal_Chronic" and "chronic_pts".

    2. About APACHE 2 Chronic Disorder coding -- Allan and Tina to Zoom to interactively resolve this issue.

    3. Update about when Visit Admit DtTm in Cognos is DIFFERENT for records included within a single hospitalization.

    • Tina reports that she has not received any such issues from Pagasa, and it's not clear if (a) there haven't been any vs. (b) there have been some but Pagasa has been dealing with them herself.
    • Julie or Tina to ask Pagasa about this. If 'b' then we DO want them sent to Tina so she can send them to Charity to see if they can be fixed withing ADT/Cognos.

    4. New item: Many ward patients who leave AMA have their beds held for as much as a day or two. We currently identify their disposition time as when they have physically left, but we recognized that for bed utilization purposes this may not be ideal. To help move our understanding of this issue forward, Julie generated the following data for the 3 current hospitals over a 5 year interval:

    • AMA rates over the 5 years were:
      • HSC: 3.8-7.9%
      • STB: 1.6-5.2%
      • Grace: 1.1-4.1%
    • At our next JALT meeting we will discuss whether these numbers mandate keeping track separately of timing for: (i) patient leaving the hospital and (ii) when the bed was released for reassignment.

    5. Julie reported that the QI team is interested in information on use of the FMS (Fecal Management System), though they have not yet specifically requested information.

    • After contacting Dan Roberts, Allan sent an an email on Nov 17 to Carmen Hrymak to ask if indeed the QI Steering Committee does want this information, and if so to obtain details and tell her to go directly through Dan to make the formal request.
    • Likely what they would want is similar to how we collect TISS elements, i.e. for each patient for each day in ICU whether they had, at any time, use of a FMS.

    6. Julie reported that Nephrology asked about obtaining, for CRRT patients, specifically if patients are on any form of systemic anticoagulation. Their interest is related to filter lifespan. From the email trail, it appears that they'd like to know which drug(s) the patient received. But the problem is that we only collect "Yes/No" information for any time in ICU, not specific to when the patient was on CRRT. Furthermore, we don't split out the different types of heparin.

    • Allan emailed Deborah Stanley (dStanley2@wrha.mb.ca) for clarification on Nov 17. Awaiting reply.

    7. Next JALT meeting Nov 30 at 11 am -- Allan sent a Zoom invite.

    JALT Meeting – November 10, 2022

    • Present: Julie, Allan, Lisa, Tina
    • Minutes prepared by: AG
    • Action items in BOLD

    1. About APACHE 2 Scoring

    • It was noted that over 2019-2021 there was an approximate 5 point rise in mean APACHE 2 scores limited to Grace Hospital.
    • To try and understand whether this change was real, or due to some problems with APACHE scoring, Julie will analyze the components of the APACHE score in the "pre" vs. "post" period in question.

    2. About APACHE 2 Chronic Disorder coding

    • Per Tina's 11/3/22 email to Allan, there is still a problem with how Allan specified the ICD10 codes to be included. Tina and Allan will meet to resolve these.

    3. About reporting of transfer-ready bed-days on Medicine. The issue here is that while we currently report these as of when the patient is discharged from the bed, for long-stay patients, this may "allot" those bed-days to months, quarters and occasionally even years different from when they actually occurred.

    • After discussion, given that the database records of long-stay patients remain "incomplete" until discharge, and the fact that a choice does need to be made in this regard, and the fact that the usual paradigm for this kind of issue is to assign things to when the patient is discharged ---> we agreed to keep with the current reporting paradigm

    4. Prior/ongoing JALT issues:

    • Update/reminder about when Visit Admit DtTm in Cognos is DIFFERENT for records included within a single hospitalization. Julie to forward next few of these to Tina who will analyze them, and if it seems they're an ADT/Cognos error it may require reporting it to be fixed to Charity.
    • Update/reminder about patients (ICU>Medicine) with very short LOS. Julie did an analysis and found that virtually all of these with LOS of 15 mins or less died. Increasingly as these short LOS grow longer (say to 1-2 hrs) the % who die falls. We hypothesize that for those who don't die but have LOS<2 hrs that most are getting sent from Medicine to ICU or being transferred to a different hospital. To check this out Julie will itemize, separately for Med and ICU, the dispositions of patients with LOS of 2 hrs or less who didn't die.
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