JALT Meeting - Rolling Agenda and Minutes 2023
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JALT Meeting – Feb 2, 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. Update regarding those records where ER is the first boarding loc but the patient is there for only a few minutes, or even for Zero minutes.
- Per last time, we recognized that these are real when the patient is actually in an ER bed.
- What we don't yet know is about the cases (of which Julie found 147) where patient is admitted from ED triage without being put in an ED cot.
- The crux of this issue is exactly how our users utilize this information. If, as we suspect, it is to identify opportunities for substantially reducing such ER delays, then short delays (e.g. <10 mins for sure, and prob even <20 mins) are irrelevant as they're not likely remediable. If this is the case, then for collection and reporting purposes we should only report on those with ER delays >some threshold (e.g. 30 mins).
- Allan emailed Bojan, Carmen and Roseanne about this today ---> and they replied that indeed they only care about delays that are substantial.
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2. We need to update out yearly PIA report. Tina will email the last one to Allan.
3. Discussion about the intention throughout the province to start collecting (voluntarily) on indiginous status and LGBTQ status. We recognized that this would be very interesting data to have in our databases.
- Allan related that "they" are working on a governance plan, so Tina will put a reminder on this item to revisit it December 2023.
4. Information suggests that the Dept of Medicine is (again) contemplating ceasing to fund the Medicine database.
- Allan spoke today with Bojan about this, particularly about the importance of ensuring that IF they do so, that the ICU Database will be protected. The plan is that Allan and Bojan will meet with Dr. Renner and Hana to discuss these issues.
5. Question about whether to include medicine patients on a soon-to-open ward at HSC, that might be a mixed (medicine and non-medicine patients) ward.
- Answer: Yes, but only include those on Medicine service.
6. We were informed that Hi Obs at HSC has recently had some patients on non-Medicine services (Respirology, Neurology). We agreed that we will only include the Medicine patients in our database.
7. Update on Charlson comorbidity coding. Allan to respond to the email sent by Tina on Jan 26, 2023.
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.
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For earlier minutes see JALT Meeting - Rolling Agenda and Minutes 2022