JALT Meeting - Rolling Agenda and Minutes 2023

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List of items to bring to JALT meeting

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HSC-GA7S JALT
  • This same location has different levels of care over time. Currently the s_level_of_care table can only accommodate one, ie changes over time can't be included in it. My first thought was to include start and end times for this, but what if patients from both programs were boarding on a given unit at the same time? Can that happen? The very concept that these are boarding locations kind of means crazy things could go on. How do we best accommodate this? Would we always know as a physical location (especially a boarding one) changes LOC? Ttenbergen 13:53, 2022 October 13 (CDT)
2022-11-03 10:31:16 PM
Non-standard ICD10 Diagnoses Dx grouping
  • With our addition of codes, collectors may use one of our codes rather than the closest standard ICD10 code. In that case, the dx would not show up in the range. How should we address this? The most likely candidates above seem Bronchiolitis obliterans organizing pneumonia (BOOP, cryptogenic organizing pneumonia (COP)) and SARS (severe acute respiratory syndrome)
    • AG REPLY -- for this nonstd BOOP code, there are no existing issues regarding any of the comorbid groups (e.g. Charlson)
      • Allan, could you confirm that that this is what we found when we looked into BOOP.
  • AG REPLY --- so far Tina the only 2 U-codes that would ever be a primary dx are U04 and U14.68 -- which belong respectively to ICD10 chapters J and E. But whenever we add a new U-code we need to remember to decide which chapter (if any) it needs to be included under. Tina to add to template.
    • I can't add this to the template, this is not how templates work, they won't warn me as I start a new dx page. We'd need to remember this some other way. And I just saw other dxs that might fit in here: Diabetes mellitus acute complication: Non-ketotic hyperosmolar state, Asystole, Pulseless Electrical Activity (PEA)
    • Actually, neither BOOP nor SARS would currently be captured by our APACHE Acute Dxs in ICD10 codes filter - they likely should be. So this is still an issue and we would miss them if we did something similar. How do we fix it for the Apache codes and prevent this problem going fwd? Ttenbergen 15:22, 2022 June 30 (CDT)
      • Discussed at JALT, Allan will review. Ttenbergen 10:32, 2022 August 24 (CDT)
        • Allan sent an email 2022-10-02 that provides a new inclusion list for some of these. Nothing for APACHE or Charlson Comos, but additions for APACHE Acute Dxs in ICD10 codes. Tina needs to process the additions into S ICD10 APACHE Dx patterns table. Ttenbergen 16:54, 2022 October 27 (CDT)
        • Additionally, Tina will provide Allan the filter info as it's stored in Access so that future updates aren't confusing. Ttenbergen 17:00, 2022 October 27 (CDT)
        • Additionally we need some way to make sure we consider this when we add dxs. Ttenbergen 17:00, 2022 October 27 (CDT)
  • figured out that the structure of APACHE Acute Dxs in ICD10 codes is way different than I had thought and that my current implementation can't accommodate it, reviewing with Julie. Ttenbergen 23:09, 2022 October 27 (CDT)
  • 2022-10-28 4:09:28 AM

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    JALT Meeting – January 11/12, 2023

    • Present: J,A,L,T
    • 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. RESOLVED ITEM: Followup about APACHE 2 Scoring. We now believe it is correct.

    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 Chastity to see if they can be fixed withing ADT/Cognos.
      • Tina emailed Pagasa about this December 8, 2022 but hasn't heard back, and again 2023-01-25.

    3. RESOLVED ITEM: Regarding the new infrastructure to separately record both Dispo DtTm field (for when the patient is no longer under our care) and BedHeldEnd DtTm (for when the assigned bed is released).

    • This only applies to situations when patient vacates the bed but it is "held" for expected or possible return of the patient.
      • The main such situations are the patient does NOT return after: (a) going elsewhere for a procedure, or (b) leaving AMA and the bed is held for a day or 2 hoping she/he will return. Which of these occurred is recorded in TEMP.
    • Today we recognized another such situation: Patient living at St.Amant had a PEG, went back to St. Amant hoping he'd do well, but the hospital bed was held for a day just in case. As this situation isn't covered by recording AMA or Procedure in TEMP, we agreed to add another possible TEMP entry for such occurrence, to be named something like "Other" or "Weird Reason". Tina has added this option to CCMDB as part of CCMDB.accdb Change Log 2023#2023-01-25.
    • Julie also inquired about how to now report about bed-days and occupancy. After discussion, we agreed that she will alter reporting as follows:
      • Primarily report on days patients were in beds being cared for in those beds (i.e. from Admit DtTm until Dispo DtTm.
      • But also report the ADDITIONAL cumulative days when beds were held with the expectation patients would return to them, but did not, as directly above.

    4. RESOLVED ITEM: 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.
    • Allan asked Bojan if this plan is OK, and he said yes.

    5. RESOLVED ITEM: 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. RESOLVED ITEM: 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.

    • Though we first thought this is a phenomenon of incomplete charts, Julie checked and it is NOT. After discussion we determined that this is a real phenomenon that occurs when ICU/ward team only agrees to accept the patient once a bed is available, and that once that happens the patient IS quickly transferred from ED to ICU or ward.

    7. In looking into #6, Julie noticed that there are 2 sorts of admissions about which she is concerned:

    • (1) Direct admit without passing through ED at all. These are real, and almost certainly are direct admissions from clinics to wards. So not a problem.
    • (2) Admit from ED triage without being put in an ED cot. Again, these may well be real, and if so likely are admissions to wards (rather than ICUs). Julie will send a few of these to Lisa, who will check on them.

    Previous

    For earlier minutes see JALT Meeting - Rolling Agenda and Minutes 2022