JALT Meeting - Rolling Agenda and Minutes 2023
List of items to bring to JALT meeting
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| Decubitus (pressure) ulcer, stage not indicated | JALT Met with Andie and she asked if we can add deep tissue injury as a category for pressure ulcers, and also if we can add the options of a location with each stage, coccyx/buttocks, heels, and other. SICU has just finished a project looking at pressure injuries and the use of a preventative drsg. SBGH/MICU/IICU are also planning to adopt this drsg and would like this data. Lisa Kaita 11:58, 2024 December 20 (CST) | 2024-12-20 5:58:35 PM |
| Level of care hierarchy | JALT
| 2024-12-17 3:41:16 PM |
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JALT Meeting – January 11, 2023
last minutes from 2022 as starting point for this year, pls update/overwrite
- Present: ___
- 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. Followup about APACHE 2 Scoring
- Possible issue: When Allan summed the APS elements he got a slightly different mean value from the automatically calculated version. Julie to check on her automated calculation
- Tina and Julie will remove one of the (now identical) fields "ApTotal_Chronic" and "chronic_pts".
2. Visit_Admit_DtTm differences within same admission
- 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.
- 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.
- Tina emailed Pagasa Ttenbergen 11:22, 2022 December 8 (CST)
3. BedHeldEnd DtTm - Per the last JALT meeting, the frequency of people leaving AMA (esp from ward) is not low. And, per Lisa, most of these are without notice. Thus it is not a trivial issue that there is a nontrivial difference between when the patient actually stops being under care vs. when the bed is released for reassignment.
- We agreed this mandates keeping track of both of these dates/times. Furthermore, a similar phenomenon occurs when a patient is sent to another hospital for a procedure, expecting to return (so the bed from the sending site is held) but then does not return.
- These 2 situations are easy for the DCs to identify and they always do so.
- So we will distinguish between:
- (a) Actual time under care, which is from Admit DtTm to the patient's Dispo DtTm -- we'll call this the patient's length of stay
- (b) What we'll call "Bed Assigned Time", i.e. from Admit DtTm to the time when the bed is released for reassignment, which we will call "BedHeldEndTime". This latter is generally available from Cognos (ADT), and Tina will create machinery to record BedHeldEndTime as a temp item. As above, this will ONLY be recorded in the situations when a patient leaves AMA but the bed is held for a bit hoping they come back (but they never do so) , or patient goes elsewhere for a procedure expecting them to return so bed is held but they never do come back.
- There will be 2 versions of BedHeldEndTime, i.e. BedHeldEndTime/AMA and BedHeldEndTime/Procedure.
4. Repeat item, regarding how to record time spent waiting for transfer (after Transfer Ready DtTm):
- We had previously decided to: (a) ignore such transfer delays <2 hrs, but (b) for all delays >=2 hrs to use the actual delay time.
- But this seems to conflict with the prior national Vital Signs Monitoring program (which is now defunct) which substracted 2 hrs from all actual delay intervals.
- Allan's rationale for not subtracting 2 hrs is as follows: While there are seemingly obligate delays in transferring a patient out (sending site getting the patient ready to travel and ensuring personnel are available, getting bed cleaned an ready in the accepting site and ensuring personnel are available) the concept of any given interval for these to occur is counter to the concept that we can and should always be striving to make out systems more efficient and reduce those delays.
- So, today Allan emailed Carmen, Rosanne and Bojan to get their input on this.
5. New question: How to deal with transfer delay in a recent case where patient in ICU was made ACP/C and then palliative ---> didn't die and indeed improved --> reversed the ACP/C and patient left ICU alive 7 days later.
- After discussion, we agreed that this is an extremely rare occurrence, and that rather than make a new rule for it, we will stick with the existing rule that transfer delays be calculated from when first transfer ready until the patient leaves. And also, this example is not fundamentally different from when a patient is ready to leave but gets sicker and the transfer is cancelled.
6. New question: Julie identified that there are cases (esp at St. B ICUs) where ER is the first boarding loc but within a few minutes (or sometimes simultaneous with) that boarding loc, a 2nd boarding loc of ICU is recorded.
- We think this most likely is a phenomenon of incomplete charts and so at our next JALT meeting Julie will let us know if this still occurs (and the # of them) in complete charts. Also, Lisa will ask the ICU DCs at St. B about this.
7. Next JALT meeting January 11, 2023 at 10 am -- this may be our last JALT meeting.