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{{LegacyContent
|explanation=Will be included in ICD10
|successor=[[Targeted Temperature Management (TTM)]]
|content=
[[Task Team Meeting - Rolling Agenda and Minutes#ICU Database Task Group Meeting – November 8, 2018 | DB task meeting minutes Nov 8.18]]-- User:TOstryzniuk|Trish Ostryzniuk]] 13:41, 2018 December 24 (CST) -->
{{Project
{{Project
  | Project = {{PAGENAME}}
  | Project = {{PAGENAME}}
  | ProjectActive = active
  | ProjectActive = active
  | ProjectProgram = CC
  | ProjectProgram = CC
  | ProjectRequestor = unknown
  | ProjectRequestor = Dr. Dean Bell/Dr. Kendiss Olafson
  }}  
  }}  


'''BRR/XBR''' is an entry we use to identify whether patients are receiving therapeutic hypothermia (Targeted Temperature Management or TTM) following a '''cardiac arrest''' according to the [[Cardiac Arrest Cooling Protocol]]. By identifying all patients that receive this therapy a further audit can be done to identify if therapy was appropriate or not.
{{TT | question =
* start and stop date should be in table? [[User:TOstryzniuk|Trish Ostryzniuk]] 13:56, 2018 December 24 (CST)
** yes, it's somewhere on my list to change all the tmp project templates to have the dates built in. Tagged now so staying on the list. }}
 
'''BRR/XBR''' is an entry we use to identify whether patients are receiving therapeutic hypothermia [[Targeted Temperature Management (TTM)]] following a '''cardiac arrest''' according to the [[Cardiac Arrest Cooling Protocol]]. By identifying all patients that receive this therapy a further audit can be done to identify if therapy was appropriate or not.
We do '''not track cooling for reasons other than cardiac arrest'''.
We do '''not track cooling for reasons other than cardiac arrest'''.


=={{G | Guidelines}} / Collection Instructions ==
== Guidelines / Collection Instructions ==
For any ICU patient with one of the following diagnoses:  
For any ICU patient with one of the following diagnoses:  
* [[Witnessed Cardiac Arrest|Cardiac Arrest Witnessed 100-2]]  
* [[Cardiac arrest]]
* [[Unwitnessed Cardiac Arrest|Cardiac Arrest Unwitnessed 100-1]]   
 
code in TMP follows:  
or pre-ICD10:
* [[Witnessed Cardiac Arrest]]  
* [[Unwitnessed Cardiac Arrest]]   
 
Code in TMP follows:  
* Project: Cooling  
* Project: Cooling  
*item
*item
**'''BRR''' (BRR stands for "Brrrr" as in shivering or cold)
**'''BRR''' (BRR stands for "Brrrr" as in shivering or cold)
*** cooling protocol was applied >= 12 hrs  (unless patient died before)
*** cooling protocol was applied at any point post arrest
*** cooled for >= 12 hrs prior to arrival to your ICU
**'''XBR''' - no cooling protocol applied
**'''XBR''' - no cooling protocol applied, or applied for < 12hrs
** '''Do not code BRR or XBR''' when a cooling protocol is used to normalize temperature for any type of '''non-cardiac arrest''' patients.


=== how important is the 12 hr part? ===
'''Do not code BRR or XBR''' when a cooling protocol is used to normalize temperature for any type of '''non-cardiac arrest''' patients.
{{Discuss@task | how important is the 12 hr part?}}
We want to capture all patients who are cooled post '''cardiac arrest''' '''''whether they meet criteria for [[Cardiac Arrest Cooling Protocol]] or not'''''. A significant portion of patients following cardiac arrest do not meet ''all'' the criteria listed, however, based on the available evidence it is reasonable to consider cooling them.
{{Discussion}}
* I wonder how important it is to exclude the patients that are cooled less than 12 hours?  Sometimes the patient is only in the unit a shorter time after arrest and they may die '''or''' it is difficult to tell exactly when the TTM ended.  Would it not be better to include all TTM patients instead of excluding those that are less than 12 hours on the protocol?  --[[User:LKolesar|LKolesar]] 10:12, 2017 November 28 (CST)
** I agree with Laura. At the Concordia the charting is so poor it is very hard to tell if the cooling occured for 12 hours or not.Could we ask about this in task? [[User:GHall|GHall]] 11:40, 2018 January 22 (CST)
*** I have emailed Allan about this and put it on the list for Task meeting. Ttenbergen 12:26, 2018 February 8 (CST)
*Allan's answer:  I think we should code [[CCI Procedure]] 1.ZZ.06 [[Hypothermy]] if they start on it at all (i.e. eliminate timeline).  As indicated, the charting may be inadequate to let us know how long it was done --- and one reason it may be done only briefly is that the patient died. 
** The purpose of this field is to show whether the cardiac cooling protocol was followed. Its criteria was to cool 12-24 hrs. We used to list the whole protocol in this article and pruned it down to the 12 hr definition because it's collectable. See e.g. [https://ccmdb.kuality.ca/index.php?title=BRR&oldid=41838 this old version]]. If Critical Care or Cardiology still want to use this data to show if the protocol is being followed we would need this threshold, no? Ttenbergen 16:12, 2018 February 12 (CST)


== {{CCMDB Data Integrity Checks|implemented}} ==
== CCI ==
[[Task Team Meeting - Rolling Agenda and Minutes#ICU Database Task Group Meeting – October 3, 2018]] confirmed that we can stop collecting this when we start collecting CCI [[Targeted Temperature Management (TTM)]]. We may want to import the old entries as CCI codes? Ttenbergen 00:19, 2018 October 10 (CDT)
 
== Cross Checks ==
see [[Check BRR/XBR vs cardiac arrest dx]]
see [[Check BRR/XBR vs cardiac arrest dx]]
==CCI==
{{CCI}}{{discussion}}
If I understand right this will be coded as [[CCI Procedure]] 1.ZZ.06 [[Hypothermy]]. We will need to
* import old tmp entries accordingly
* change cross checks to the new encoding method.
* how do we ensure that all cardiac arrest patients either have TTM (targeted temperature management)or not if you use CCI? The correct term should be TTM.  Hypothermia is not always needed.  The idea is to keep the patient's temperature from going high.  Usual maintenance temp is 36 degrees.


== Background ==
== Background ==
=== Start Dates ===
=== '''Start Dates''' ===
* collection was started '''August 2004'''
* '''2004 August'''
* XBR and [[CCMDB.mdb]] cross checks were added to detect occasions where entry was just forgotten/missed '''March 19.09'''
* XBR and [[CCMDB.accdb]] cross checks were added to detect occasions where entry was just forgotten/missed '''March 19.09'''
* reviewed with Kendiss Olafson and Dean Bell.--[[User:TOstryzniuk|TOstryzniuk]] 17:58, 26 August 2009 (CDT)
* reviewed with Kendiss Olafson and Dean Bell.--[[User:TOstryzniuk|TOstryzniuk]] 17:58, 26 August 2009 (CDT)
* cross-checks changed to include [[Unwitnessed Cardiac Arrest]] '''August 27.09'''  
* cross-checks changed to include [[Unwitnessed Cardiac Arrest]] '''August 27.09'''  
* moved from ICU Var 2 into TMP on Dec 18, 2014
* moved from ICU Var 2 into TMP on Dec 18, 2014
=== '''Stop Date''' ===
'''2018 Dec 31'''
*Stop in TMP.  All patient still in unit after this date, code as: [[Targeted Temperature Management (TTM)]]


=== Why the code XBR? ===
=== Why the code XBR? ===
The rationale for the code XBR is to identify those patients who had a cardiac arrest but '''were not cooled''' regardless if they met criteria for cooling or not. XBR was implemented after an audit of cardiac arrest was done and it was found that there were several cardiac arrests coded that were missing code BRR.  By leaving Variable 2 blank for a cardiac arrest, it is not clear to Kendiss or Julie whether a data collector missed tagging it or if indeed cooling was not applied.  Coding XBR indicates to both Kendiss and Julie that a collector verfied that the cooling protocol was not applied.   
The rationale for the code XBR is to identify those patients who had a cardiac arrest but '''were not cooled''' regardless if they met criteria for cooling or not. XBR was implemented after an audit of cardiac arrest was done and it was found that there were several cardiac arrests coded that were missing code BRR.  By leaving Variable 2 blank for a cardiac arrest, it is not clear to Kendiss or Julie whether a data collector missed tagging it or if indeed cooling was not applied.  Coding XBR indicates to both Kendiss and Julie that a collector verfied that the cooling protocol was not applied.   


=== removed 12 hr requirement ===
Discussed at task 2018-04-11: we are removing the 12 hr requirement because the use and application of the protocol has changed since inception and this restriction is no longer reasonable.


== Related articles ==
{{Related Articles}}


 
[[Category:Project ICU only]]
[[Category:All Projects ICU only]]
[[Category:Arrest]]
[[Category:Arrest]]
}}

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DB task meeting minutes Nov 8.18-- User:TOstryzniuk

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