Selection and timing of APACHE components: Difference between revisions

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m (moved exceptional value instructions back to APACHE physiological variable collection because it's not part of selection or timing.)
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== Instructions ==
== Instructions ==
Choose the worst value that occurs within the 24 hours after [[Accept DtTm]].  
Choose the '''''worst''''' value that occurs '''within the 24 hours after [[Accept DtTm]]'''.  


{{Discuss |
The '''''worst''''' value could be '''high''' or '''low''', depending which gives the most [[APACHE Scoring table#Chemistry_values| points]].
This page is just a place holder for now, I am currently consolidating this info here. [[User:Ttenbergen|Ttenbergen]] 14:09, 2020 December 23 (CST)
}}


Moved here from [[Change to start collection at accept rather than arrive time]] needs integration:
The APACHE elements time frame will start in the off-ward bed location.
{{Discuss |  
{{Discuss |  
* Does it really start in ER? since that's now one off-ward location? In any case, we should really only link to the definition in APACHE from here so this doesn't become inconsistent. If someone knows where that's documented, can you please confirm and fix? Ttenbergen 00:36, 2020 October 16 (CDT)
*Does ICU start there APACHE and TISS from the ER accept time or ICU admit time. Currently we collect from the ER accept time only when the patient is boarded in the ER for greater than 2 hours. [[User:Gthomson2|Gthomson2]] 10:43, 2020 October 20 (CDT)
**I haven't been able to find it on the Wiki, but I was told to get my values for my Apache from the previous location. So for example a patient getting admitted to the ward from ER, the Apache values would be the ones just prior to their Accept Dt/Tm. Think "this was their condition when they were accepted by medicine". If it's a transfer to the ward from ICU, I take the last values before they left. [[User:Surbanski|Surbanski]] 11:14, 2020 October 19 (CDT)
*****Since Oct.15th, I have been using the 24 hour period after the accept time, which means that I am including the applicable Vitals from ER if the patient was from the ER. I wasn't at the task meeting yesterday, so I don't know if this was discussed, but this was my understanding of how we are supposed to collect apache[[User:Mlagadi|Mlagadi]] 11:02, 2020 October 23 (CDT)
** To confirm for patients admitted from ER, Apache vital signs are taken from closest to but prior to Accept Date/time?
*** Gail, where does this 2 hour delay rule come from? Is there anything on wiki about it? [[User:Ttenbergen|Ttenbergen]] 14:49, 2020 December 23 (CST)}}
***For medicine yes. I don't know if ICU does anything different. If I've been doing it wrong I expect someone from medicine at the other sites will say something :) [[User:Surbanski|Surbanski]] 10:31, 2020 October 20 (CDT)
****Dose ICU start there APACHE and TISS from the ER accept time or ICU admit time. Currently we collect from the ER accept time only when the patient is boarded in the ER for greater than 2 hours. [[User:Gthomson2|Gthomson2]] 10:43, 2020 October 20 (CDT)
*****Since Oct.15th, I have been using the 24 hour period after the accept time, which means that I am including the applicable Vitals from ER if the patient was from the ER. I wasn't at the task meeting yesterday, so I don't know if this was discussed, but this was my understanding of how we are supposed to collect apache[[User:Mlagadi|Mlagadi]] 11:02, 2020 October 23 (CDT)}}


From [[APACHE physiological variable collection]], needs integrating:
== Iatrogenically changed values ==
Select the physiological values that reflect the '''worst''' deviation from normal in the '''first 24 hours''' while "in" the ICU. The clock starts at the '''[[Arrive DtTm ]]'''. If the length of stay in ICU is less than 24, use those values only.
Keep in mind the diagnosis and try not to include iatrogenically modified values, e.g. BP severely high due to inotropes or decreased LOC due to sedation.
{{DiscussTask |
We decided that a record starts at service acceptance, not unit arrival. This was partly to change the strange exception of [[EMIP]]s. So should this still be "in ICU" or should it now be "on ICU service"?  [[User:Ttenbergen|Ttenbergen]] 13:31, 2020 November 25 (CST)
}}
{{DiscussTask |
We use different instructions for Medicine: [[ALERT Scale timing of assessment]] - can and should those be unified? [[User:Ttenbergen|Ttenbergen]] 13:34, 2020 November 25 (CST)
}}


The ''Worst'' value could be '''high''' or '''low''', depending which gives the most [[APACHE Scoring table#Chemistry_values| points]].
However, if a value is assessed as part of testing whether an intervention works, that value is not necessarily ineligible (e.g. see [[Arterial_blood_gas_(APACHE)#ABGs_as_part_of_apnea_tests]]).  
Keep in mind the diagnosis and try not to include iatrogenically modified values, e.g. BP severely high due to inotropes or decreased LOC due to sedation.


== Log ==
2020-?? (possibly Oct 15)
* used to start at [[Arrive DtTm]], now starts at [[Accept DtTm]]


== Related articles ==  
== Related articles ==  

Revision as of 15:49, 2020 December 23

This page explains how to select physiological or GCS values for entry into the fields used for Apache in CCMDB.accdb.


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)
  • SMW


  • Cargo


  • Categories

Instructions

Choose the worst value that occurs within the 24 hours after Accept DtTm.

The worst value could be high or low, depending which gives the most points.

  • Does ICU start there APACHE and TISS from the ER accept time or ICU admit time. Currently we collect from the ER accept time only when the patient is boarded in the ER for greater than 2 hours. Gthomson2 10:43, 2020 October 20 (CDT)
          • Since Oct.15th, I have been using the 24 hour period after the accept time, which means that I am including the applicable Vitals from ER if the patient was from the ER. I wasn't at the task meeting yesterday, so I don't know if this was discussed, but this was my understanding of how we are supposed to collect apacheMlagadi 11:02, 2020 October 23 (CDT)
      • Gail, where does this 2 hour delay rule come from? Is there anything on wiki about it? Ttenbergen 14:49, 2020 December 23 (CST)
  • SMW


  • Cargo


  • Categories

Iatrogenically changed values

Keep in mind the diagnosis and try not to include iatrogenically modified values, e.g. BP severely high due to inotropes or decreased LOC due to sedation.

However, if a value is assessed as part of testing whether an intervention works, that value is not necessarily ineligible (e.g. see Arterial_blood_gas_(APACHE)#ABGs_as_part_of_apnea_tests).

Log

2020-?? (possibly Oct 15)

Related articles

Related articles: