Task Team Meeting - Rolling Agenda and Minutes 2024

List of items to bring to task meeting

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Chronic Health Facility	We have had patients admitted from the chronic care unit at Deer Lodge (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? Lisa Kaita 12:32, 24 November 2025 (CST) They live there, so that makes this also related to Collection of locations on the spectrum between home and PCH. Ttenbergen 18:00, 27 November 2025 (CST) so we will continue to enter as Chronic health facility for now Lisa Kaita 07:43, 28 November 2025 (CST)	2025-11-28 1:43:16 PM
Diabetes mellitus chronic complication: Nephropathy	I have a patient that has had a pancreas transplant and this has cured his diabetes. He still has retinopathy, neuropathy, etc. Can I code all of the complications of diabetees without linking them to Diabetes mellitus type 1, with chronic complication (code complications separately)"Mlagadi 09:17, 4 February 2026 (CST) The program should let you do it - I added the tag that would flag cross checks for this diagnosis to the bottom of this wiki page and it finds nothing. I'll leave for Task to answer whether that is how we want to code it. Ttenbergen 09:59, 4 February 2026 (CST)	2026-02-04 3:59:30 PM
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
Pre acute living situation field	We found some cases where, during the same hospitalization, there are different values for this. For example, the first ward admission may have "house" and the immediate next ICU admission may have "PCH". I think there is no scenario where that makes sense. If you can think of one, tell me. For existing data like this, how would we best treat it heuristically. Would the first record be more likely to be right because the chart is still cleaner and easier to follow? Or would a later record be more likely to be correct since more of the patient's story would have emerged? Thoughts? This may arise when we complete the profiles separately ie. medicine done before ICU or vice versa, and more information may be more available in the chart, or it may have been an error where one was updated the other was not Lisa Kaita 15:32, 26 November 2025 (CST)	2025-12-17 6:07:30 PM
Publications, abstracts, presentations using the Critical Care and Medicine Database	This page is an indicator of how we fulfill the research component of the CCMDB#Purpose and Mission. To keep it useful and representative of current work, entries need to be added on an ongoing basis as new outputs occur. To make this reliable, how do we build this into our workflow (e.g., as part of the Database Request Process), so the record stays current with minimal overhead? At present this relies on post-hoc updates from requestors, which has had limited uptake.	2025-12-31 8:13:08 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
Sex field	I just came across an incomplete record (from S9 laptop) that has a sex entry "Undiff". Our dropdown doesn't contain this so this likely came from Cognos. If this is now being coded in EPR, and considering that this would affect the "biological sex" we use in defining this, should we introduce this as an option? If we do not want to introduce this as an option, do our cross checks catch this? They might not, since this could not have been entered manually. Ttenbergen 00:16, 12 November 2025 (CST)	2025-11-12 6:16:35 AM
St.Amant	Since 2022: Pre acute living situation for patients where Dispo is St Amant has been recorded as: 23 Chronic Health Facility 14 Community Facility with support 5 Personal Care Home 2 House 1 other - known but not listed 1 Apartment Pre acute living situation for patients where Previous Location is St Amant has been recorded as: 1 Apartment 1 Personal Care Home How are we using this code, and how should we use it? Ttenbergen 16:07, 29 October 2025 (CDT) * When I have seen this in a chart the address is usually 440 River Road, which is the St Amant facility, I code it as per the wiki instructions, as a chronic care facility. I know that St Amant has several group homes as well, but I wouldn't know their addresses and the documentation is usually not that specific to include who manages the group home. With the new dispo options, group homes would be transfer to group/supportive housing Lisa Kaita 15:46, 26 November 2025 (CST)	2025-11-26 9:46:22 PM
Template:Decubitus Stage not indicated Details	This instruction is taken from old dx Decubitus (pressure) ulcer, stage not indicated; since we will now have a series of codes for suspected deep tissue injury, we need to change this, but what should be here, and what should move into Template:Decubitus Deep Tissue Damage Details? Ttenbergen 15:29, 30 June 2025 (CDT) This page should remain the same, deep tissue injury is really considered to be a different way to stage/document decubitus ulcers An unstageable ulcer is still used in documentation and grading of decubitus ulcers Lisa Kaita 20:23, 7 October 2025 (CDT)	2025-10-08 1:25:23 AM
Template:Decubitus Stage not indicated Details	This instruction is taken from old dx Decubitus (pressure) ulcer, stage not indicated; since we will now have a series of codes for suspected deep tissue injury, we need to change this, but what should be here, and what should move into Template:Decubitus Deep Tissue Damage Details? Ttenbergen 15:29, 30 June 2025 (CDT) This page should remain the same, deep tissue injury is really considered to be a different way to stage/document decubitus ulcers An unstageable ulcer is still used in documentation and grading of decubitus ulcers Lisa Kaita 20:23, 7 October 2025 (CDT)	2025-10-24 2:28:08 PM

Also see Task Team Meeting - Rolling Agenda and Minutes 2022

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ICU Database Task Group Meeting – January 11, 2024

• Present: Allan, Lisa, Stephanie, Val, Julie, Mindy, Pam, Mailah, Joanna, Gail
• Minutes prepared by: AG
• Action items in BOLD

1. Followup discussion about patients who have different or otherwise contradictory postal codes during a single episode of care involving hospital-to-hospital transfers. There are 2 kinds of these:

• FIRST: one hospital record indicates a valid postal code while the other has "na" for the code. There are 2 possible scenarios here:
  • (1) We note that the postal code field should contain "na" when the patient is homeless, and that homelessness per se is a response option in the data field of pre-admit location.
    • It became clear in discussion that the collectors spend considerable effort validating homelessness, so based on that we decided that when it is present in the pre-admit location field that we will take that as correct, and that all postal codes in that episode of hospital care (i.e. across the hospital-to-hospital transfers) should be fixed to be "na" and all the pre-admit locations should be listed as "homeless".
    • Furthermore, Julie will go back and make it so all past records meet this new rule as well.
    • Lisa will alter the Wiki so that it no longer says that for homeless patients who are living at a shelter, to list the postal code of the shelter. Instead it will say to list that postal code as "na".
  • (2) None of the pre-admit locations were "homeless". We decided when this occurs, Julie/Pagasa will work to discern the true situation.
• SECOND: both hospital records list valid, but different, postal codes.
  • In discussion it was clear that there are numerous possible explanations for this and so we decided that when this occurs, Julie/Pagasa will work to discern the true situation.

2. Followup on item#3 in the November 2023 minutes, in regards to patients who present to ED at a given hospital and have ICU team involvement while in ED, but subsequently either die in ED or are transferred to another hospital (e.g. from Grace ED to Gold surgery at HSC). Specifically the question is about if/how to include them in the ICU database, and if so exactly when to code the ICU team as beginning to provide care.

• The plan at that meeting was to start and figure out how to proceed at Grace, and thereafter to decide what to do for St. B and HSC. To get going on that, Barret was going to speak to Heather Smith.
• As he was not able to attend today's meeting, Allan sent Barret an email today to inquire about that discussion. Awaiting reply.

3. About the dramatic and sustained increase in only Stage 1 and 2 decubitus ulcers starting January 2022, and only at Grace.

• Gail & Mindy reported that although there had been a change in the ICU flowsheet at Grace, that this occurred before 2022, and that furthermore, the part of the new flowsheet recording decubs was identical to the old flowsheet.
• In discussion we wondered whether this issue might be due to a change in education/guidelines for the Grace ICU nurses about identifying and recording early stage decubs. To try and get at that, Allan will directly contact the Nurse Educator at Grace ICU, Chantal Packulak.

ICU Database Task Group Meeting – November 23, 2023

• Present: Allan, Pagasa, Pam, Joanna, Barret, Julie, Brynn, Mailah, Val, Gail
• Minutes prepared by: AG
• Action items in BOLD

1. Regarding the prior idea to expand our ICD-10 coding to include ALL actual ICD-10-CA codes.

• Lisa reports that while this was generally supported in talking to the data collectors, there was also a sense that we should delay further discussion on this until a more opportune time.

2. Julie reports that she has noted some patients who have different or otherwise contradictory postal codes during a single episode of care.

• We note that postal codes derive from the ADT/Cognos system.
• As it's unlikely that more than a trivial number of patients are moving residences over such a short timespan, we need more details about this and Julie will obtain such information for us to discuss at the next Task meeting.

3. An issue arose about patients who present to ED at a given hospital and have ICU team involvement while there, but subsequently either die in ED or are transferred to another hospital (e.g. from Grace ED to Gold surgery at HSC). Specifically the question is about if/how to include them in the ICU database, and if so exactly when to code the ICU team as beginning to provide care.

• This question is complicated by a wide range of types of care provided by the ICU team in ED. It continuously spans from consultation with small actual involvement, all the way up to functionally taking over care while in ICU. While the latter should be included in the ICU database, the former should not. And of course there's everything in between.
• Part of this is that putting in an ICU admission for such a patient in ED results in the ICU team having to write a discharge summary and transfer note -- which is paperwork we'd seek to avoid.
• For Grace we discussed 2 possible solutions, both involving the ICU attending making a judgement for ED patients in whom they are contributing to care whether or not to count that person as "being on the ICU service" even if she/he never gets to an ICU in that hospital:
  • Actually put in an ICU admission
  • Don't put in an ICU admission, but record such patients in a separate portion of the ICU logbook.
  • Barret will discuss this with Heather Smith and report back at the next Task meeting.
• After we come up with a solution for Grace, we will need to discuss solutions for HSC and St. B.

4. About coding decubitus ulcers.

• We validated that when an acquired diagnosis should be entered for both de novo decubs that develop in ICU, and for progression of pre-existing decubs (e.g. from Stage 2 to Stage 3).
• We also looked at data on ICU-acquired decubs from Grace over time. This arose because the rate of such ulcers developing or worsening in the Grace ICU seem much higher than in other ICUs. It is not clear whether Grace is high or other ICUs are low. Upon further assessment, these rates rose precipitously from last quarter of 2021 to the 1st quarter of 2022. Most likely this coincides with some change in how decubs are recorded.
  • Gail will seek information about if/how such changes in recording of decubs may have happened from Jan 2022 onwards.

2023...

Also see Task Team Meeting - Rolling Agenda and Minutes 2023