Allan's links

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Allan offered to help us out with the documentation. This page lists things that need attention.

specific questions for Allan

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edit page question ModDate
edit page question ModDate
edit Task Team Meeting - Rolling Agenda and Minutes 2020 2021-01-07 4:44:49 AM
edit Task Team Meeting - Rolling Agenda and Minutes 2020
  • 1 - May be inconsistent with Admit Procedure, what do we want?
  • 2021-01-07 4:44:49 AM
    edit What is a service admission
  • Allan discussed with someone at STB what should be entered for Service with STB mgr of admitting Chantal Plaetnik.
  • Confirmed with Allan that this is still in progress and should move forward today. Ttenbergen 09:46, 2020 November 26 (CST)
  • STB Med flagged various pts where Service in Cognos doesn't match with services in orders. There is still something going on here, and I don't know how to troubleshoot it. Ttenbergen 12:01, 2020 December 10 (CST)
  • 2020-12-15 4:41:30 PM
    edit S ICD10 APACHE Como patterns table
  • Allan, if you have a reference, ideally online, for what you used to make the APACHE comorbid ranges, please add it here.
  • 2019-11-05 4:27:05 PM
    edit Template:ICD10 Guideline Signs Symptoms Test Results not needed when cause known
  • Apply it to symptoms, physical exam findings, and radiologic findings, but NOT to laboratory findings.
    • I don't know which those would be. If we go through with this definition we should just stick them into a : or similar. Category:Testing also contains non-lab findings. Where would this leave things like Fecal occult blood test, positive? The "What links here" link on the left would show all that currently links to this page.
  • 2020-11-02 2:37:57 AM
    edit Definition of a Critical Care Laptop Admission
  • As per Task_Team_Meeting_-_Rolling_Agenda_and_Minutes_2020#ICU_Database_Task_Group_Meeting_.E2.80.93_November_18.2C_2020 I was supposed to fix this to state that for pts in PACU, they are to be included if critical care, but not if surgery. Not sure how to integrate above... Ttenbergen 17:01, 2020 November 18 (CST)
  • 2020-12-23 4:03:03 PM
    edit Allan's links
  • I have noticed that the majority of COVID Pos patients have myalgias, fatigue, or malaise. Would it be possible to have a code for these three symptoms.Gens 12:27, 2020 October 16 (CDT)gens
  • 2021-01-12 8:03:59 PM
    edit What is a service admission
  • Service history information is available in EPR, but the data collector role doesn't have access to it. INC000004363742 was created to get access. As of 2020-11-25, this was put on hold by eHealth.
    • Allan will follow up with Don Thiessen. Ttenbergen 09:46, 2020 November 26 (CST)
  • 2020-12-15 4:41:30 PM
    edit CCI
  • These two are broken - do you use different reference now?
  • 2020-11-14 3:58:48 AM
    edit Level of care hierarchy
  • we are confused about the distinction with "lower level of care" with NTU... how do we resolve that? Ttenbergen 14:50, 2020 October 19 (CDT)
  • 2020-10-27 5:31:36 PM
    edit Swap Locations
  • Would it make sense to talk to STB about how the swing beds are used by ER? I don't think talking to anyone about how the swing beds are used by er would be helpful. I've explained in great detail a number of times, to a number of people why this occurs. I can't think of anything different that could potentially be done to work around the issue as it occurs in the first place. DPageNewton 10:59, 2020 December 3 (CST)
  • 2020-12-15 9:13:35 PM
    edit Change to start collection at accept rather than arrive time
  • For ICU patients we will decide on a Minimum data set of TISS items to be collected when patients are boarding. These will have to be recorded by collectors.
    • Of note, Tina reports that the DSM data we’re getting DOES include labs from the time in ED, so she will simply need to include the lab data from the time when our service takes over care.
  • Regarding the “machinery” for this -- discuss next time expanding the “Boarding Location” machinery to initial admission and all moves thereafter. In this schema, the name would be changed to something like “Physical Locations”, and the initial one would be wherever the patient was when he/she first began to be cared for by the service/team. This machinery can then easily be used by Julie to report on boarding, lengths of stay and every other aspect of location and timing of care. Because such moves are much more frequent and confusing for Medicine than ICU, as suggested by Michelle, for Medicine patients we would have only 3 possible physical locations: ED, their service location, or a generic boarding location which is not further subdivided.
  • We began to discuss that with the above changes, and the increased boarding that will likely become the norm, it would be simpler to keep track of database records not as we do now (i.e. by home location) but rather by home service. The machinery discussed above will allow Julie to write SAS code to slice and dice the information in any way desired -- e.g. time in each physical location (including high obs). After we discuss this more next time, Allan will talk to Drs. Renner/Hajadiacos if they see any major problems with such a change in process.
    • Allan confirmed that Hajidiacos is fine with this. Ttenbergen 12:01, 2020 October 27 (CDT)
  • 2020-12-23 8:09:05 PM
    edit Admit Diagnosis 1
  • that probably also ties in with Attribution of infections then?
  • 2019-09-22 4:45:28 PM
    edit Comorbid Diagnosis 1
  • that probably also ties in with Attribution of infections then?
  • 2020-05-28 6:11:50 PM
    edit Template:ICD10 Guideline Como vs Admit 1
  • that probably also ties in with Attribution of infections then?
  • 2020-10-27 10:16:52 PM
    edit ALERT Scale timing of assessment APACHE
  • Should we merge this with Selection and timing of APACHE components? Med doesn't collect all of these, but those that are collected should probably be collected following the same instructions... This especially should be reviewed since we no longer make a distinction between EMIPs and inpts for most other instructions. Should this instruction instead simply be:
    • "Use the most recent value before service acceptance. If no value is available before service acceptance, use the first value available after service acceptance."
  • if we reject this change, we should at least state once and for all that they are similar but different, and why. Ttenbergen 14:29, 2020 December 23 (CST)
  • 2020-12-23 8:29:52 PM
    edit Selection and timing of APACHE components APACHE
  • ALERT Scale timing of assessment uses slightly different definition, but it is closer than it used to be now that we start Apache at accept rather than arrive. Can we combine? Ttenbergen 14:26, 2020 December 23 (CST)
  • 2020-12-23 8:50:40 PM
    edit S ICD10 Chapter block pattern table Broken link, do you use different reference now?
  • https://www.cihi.ca/en/icd-10-ca-chapters
  • 2020-11-14 4:00:06 AM
    edit Controlling Dx Type for ICD10 codes Como Admit Acquired Primary Limits 1/ Dx grouping - this is part of both of those discussion
  • I have emailed Allan the table with all Dxs to set them as Como_allowed, Admit_allowed, Acquired_allowed. Will set up infrastructure to contain this once I have data. Ttenbergen 12:31, 2019 February 13 (CST)
    • Allan won't have a chance to review until at least mid Sept 2019
  • 2019-10-04 4:07:08 PM
    edit Admit Diagnosis Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review 2019-09-22 4:45:28 PM
    edit Comorbid Diagnosis Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review 2020-05-28 6:11:50 PM
    edit Template:ICD10 Guideline Como vs Admit Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review 2020-10-27 10:16:52 PM
    edit S ICD10 Charlson Como patterns table Como Admit Acquired Primary Limits - this is part of that discussion - if we want to limit some of these to not being allowed as admits, it will likely have to be done here.
  • AG REPLY --- yes we can and should go through ALL ICD10 codes and indicate which of the 3 Dx Types they're allowed in (ie deal with Controlling Dx Type for ICD10 codes). AG needs to be reminded to deal with this around June 2019
  • 2019-04-30 1:52:12 PM
    edit Check ICD10 some cant be primary Como Admit Acquired Primary Limits - Category:Mechanism would need to be excluded as well, and so would past history, and quickly the list gets so large again that we are back at discussing Controlling Dx Type for ICD10 codes where we should simply include "Primary"-ability.
  • AG OBSERVATION --- we will just take care of this when we take care of Admit/Comorbid/Acquired
  • 2019-09-22 4:44:08 PM
    edit Cardiac arrest Como Admit Acquired Primary Limits 1/ Dx grouping - this is part of both of those discussion
  • Should we be coding cardiac arrest as a comorb if they have a past history of cardiac arrest? Or is it considered resolved? Some of us are coding it as a comorb and some of us aren't. Thanks - Brynn
    • I think Comorbid_Diagnosis#When_not_to_code_a_dx_at_all answers this, but you say some people code it differently. Could someone who codes this as a comorbid explain why they code it? I want to flag this for my meeting with Allan to address collector questions, and I think we will need to know what the reasoning is. Ttenbergen 09:30, 2020 August 26 (CDT)
      • I have included this code for a patient with a fairly recent arrest and also to highlight the extent of their CAD and comorbs. I would also likely include it if the admitting diagnosis is cardiac related.
  • --Mailah Damian 13:08, 2020 September 4 (CDT)

    • AG REPLY --- cardiac arrest is a manifestation of a disease (examples include arrythmias, coronary artery disease, acute MI, etc). Thus it should NOT be coded as a comorbid disorder
      • TT note: See Controlling Dx Type for ICD10 codes - we can instruct not to code this specific code as a comorbid, but the problem is likely more widespread and should be addressed that way
    2021-01-12 7:55:26 PM
    edit S ICD10 APACHE Dx patterns table dx grouping

    if you have a reference, ideally online, for what you used to make the APACHE comorbid ranges, please add it here.

    • AG NOTE TO SELF -- you have to go through and confirm the ICD10/CCI codes to automatically code for the AP2 comorbs
    But mainly I used this ref: https://rstudio-pubs-static.s3.amazonaws.com/231351_940f14aa51a6427a9e92d5a04daefc3e.html
    2020-03-18 3:09:22 PM
    edit Hypoalbuminemia, severe I see you removed the link to the guideline:

    Symptom/Sign/Test Result not needed when cause known

    • This code identifies a symptom or a sign, or an abnormal test result, not a disorder.
      • So, you should code the cause of the symptom/sign/abnormal test, if known -- and if you do so, then also coding and combining the symptom/sign/abnormal test result to that cause is generally optional, but is guided by the following guidelines.
    • Here are guidelines for whether or not to ALSO code the symptom/sign/abnormal test when you DO code the underlying cause:
      • If it is a subjective symptom (e.g. pain) then coding it is optional
      • When it is a physical exam finding (e.g. abdominal tenderness) then coding it is generally optional
        • An exception is when the symptom/sign/abnormal testis so severe that all by itself it mandates hospitalization and/or a procedure -- a good example is a patient who has Wegener's granulomatosis is admitted due withHemoptysis. Since hemoptysis is a physical finding that fits this description of "severe" it should be coded, and combined with Wegener's.
      • When it is an abnormal laboratory finding which in and of itself has relevance (e.g. hyperkalemia, hypoalbuminemia) then USUALLY code it
        • You don't need to code the abnormal lab finding is when it is actually a major component of the underlying cause --- example is when a person presents with an acute MI, there is no need to code the abnormal troponin as Abnormal blood chemistry NOS
      • The trickiest of these guidelines is for abnormal radiologic tests
        • When the abnormal test is fully explained by the underlying diagnosis/diagnoses (e.g. pneumonia as cause of abnormal chest imaging, or a skull fracture with an intracranial hemorrhage both identified by an abnormal head CT) then coding the abnormal imaging result is optional
        • But remember there are some rare things for which the abnormal imaging result IS part of coding the entity, for example we code retroperitoneal hemorrhage by the combination of Hemorrhage, NOS and Retroperitoneal area, diagnostic imaging, abnormal
    • Sometimes there may be multiple symptom/sign/test result that might or might NOT be related to each other by virtue of having the same underlying cause. Since in the absence of KNOWING that cause, such assumptions may well be incorrect, do NOT combine them together if you are not certain they actually have the same underlying cause.
    That guideline says that when reasons for results are known, the results don’t need to be entered. I just want to be sure that you removed that intentionally. If you did, we should probably both review that rule (since hypoalbuminuria is now an exception that should be stated) and probably review which other pages also call that template where you now think we should code them even if the cause is known.
    2020-10-16 5:11:39 AM
    edit Non-standard ICD10 Diagnoses That link is broken, do you use a different reference now? CIHI listing 2020-11-14 4:02:07 AM
    edit Blood Product Data z
    • Identified as something we should do to streamline data collection. I have made this page to document progress toward this import.
    2020-04-23 4:25:35 PM
    edit ABG Data z
  • Identified as something we should do to streamline data collection. I have made this page to document progress toward this import. Blood gas data is in DSM listing; need to compare to see if we can use it
  • 2020-04-23 4:25:45 PM
    edit Direct Data Access for RIS/PACS z
  • Identified as something we should do; the notes below are quite old but might still be a starting point.
  • 2020-04-23 4:25:57 PM
    edit Chronic Health APACHE z
  • We are considering changing how this is collected to extracting the data from APACHE Comorbidities in ICD10 codes instead of coding a separate field. Further discussions to come. AG confirmed 2018-11-28 that this is an option
  • 2021-01-12 9:38:24 PM
    edit Template:ICD10 Guideline MRSA z "It was decided that Allan with contact Dr. Embil after COVID is over and see if we can obtain this data from Infection Control. If so, we could import it into the database, and have our data collectors cease obtaining it." - did anything come of that? 2021-01-12 8:59:00 PM