Task Team Meeting - Rolling Agenda and Minutes 2025

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Also see Task Team Meeting - Rolling Agenda and Minutes 2024

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ICU Database Task Group Meeting – February 27, 2025

  • Present: Allan, Lisa, Julie, Jen, Tina, Pagasa, Hardeep, Gail, Mailah, Michelle, Mindy
  • Minutes prepared by: AG
  • Action items in BOLD

1. Template:ICD10 Guideline Pneumonia - Continued discussion about nosocomial bacterial superinfection of viral pneumonia

  • Julie showed us the numbers, pre and post the 14-day rule took effect, of acquired Pneumonia, bacterial codes. However, as these intervals were quite different, to interpret them we must have the denominators also. Julie will prepare that data for our next Task Group meeting.

2. s_dispo table - Update about whether we should categorize locations (dispo, previous inpatient location, immediately pre-admit location) as general locations or as a specific location

  • Allan reported that Bojan indicated:
    • No need to identify specific LTC facilities
    • They do want to specify the different components of River View and Deer Lodge. Lisa will work on doing this, with Tina then to implement them.

3. Template:ICD10 Guideline Decubitus Ulcer: Update regarding SICU's desire for more details about decubitus ulcers

  • Lisa was unsuccessful so far in contacting SICU nursing leadership about how they would want to handle multiple decubs in a given site, AND how long they would want such a temp project to last. She will continue to work on that.

4. We had extensive discussion about whether or not to track (as ICD-10 diagnosis codes) specific electrolyte abnormalities.

5. Past history of Covid-19 infection: Allan reported that after discussion with Bojan, we CAN STOP collecting past history of covid-19 infection (U07.5) Retired this code Lisa Kaita 15:53, 28 February 2025 (CST)

6. Template:CCI Guideline Transfusions: New item: It was identified that different sites include/exclude transfusions in different locations, e.g. OR.

  • After discussion we agreed that going forward we will include ALL transfusions, done in any location, for a patient currently "assigned to ICU or ward". Updated the wiki Lisa Kaita 15:53, 28 February 2025 (CST)

7. Next meeting march 27 at 11 am Central Time.

ICU Database Task Group Meeting – January 29, 2025

  • Present: Allan, Lisa, Julie, Jen, Pagasa, Hardeep, Val, Gail, Mailah, Joanna
  • Minutes prepared by: AG
  • Action items in BOLD

1. Continued discussion about nosocomial bacterial superinfection of viral pneumonia

  • Jen reported on her literature review:
    • It is not uncommon -- up to 20-40% depending in the virus
    • It commonly occurs <14 days after viral onset, often within 7-10 days
    • It is difficult to identify, and the diagnosis very likely has many false-positives
  • We generally agreed we should be able to track it, and that it would be a exception to the "14-day rule" for VAP. Possible ways to track it include:
  • Before making a final decision, Julie will try and estimate the number of them comparing 2023 with 2024 (before vs. after the 14-day rule took effect)

2. Update about whether we should categorize locations (dispo, previous inpatient location, immediately pre-admit location) as general locations or as a specific location

  • Allan will followup with Bojan about this

3. Update regarding SICU's desire for more details about decubitus ulcers

  • First, we agreed to add a new sub-code: L89.96 Decubitus (pressure) ulcer, pressure-induced deep tissue damage
  • Lisa clarified that SICU desires to subdivide decubs by site into 3: posterior, heel, others
    • Lisa will talk to SICU nursing leadership about how they would want to handle multiple decubs in a given site, AND how long they would want such a temp project to last

4. New issue -- certain lab abnormalities, particularly Hypoalbuminemia, severe and Hyperphosphatemia, hypophosphotemia or other disorder of phosphate metabolism, severe or symptomatic are so common that perhaps we should modify their thresholds, or eliminate them

  • We agreed that prior to further discussion of this, Julie will identify the fraction of all patients (separately in ICU and wards) with those codes.

5. Update on whether we can we stop collecting past history of covid-19 infection (U07.5) - Allan to email Bojan

Last year's last meeting, included for continuity: ICU Database Task Group Meeting – December 4, 2024

  • Present: Allan, Lisa, Julie, Jen, Mindy, Pagasa, Hardeep, Allyson, Val, Gail, Mailah, Dan, Tina
  • Minutes prepared by: AG
  • Action items in BOLD

1. Dan explained a modification/expansion of the ward Overstay project

  • Currently we have a "transfer ready" date flag(Transfer Ready DtTm tmp entry) -- which indicates when not only the medical team, but all involved ancillary services deem the patient cleared to leave the hospital
  • We are adding a new "medically ready" flag (Project MR) -- which indicates when the ward medical team considers the patient able to leave hospital. Dan explained that he is working with the sites and the ward physicians to ensure that they identify this timepoint in the notes and/or orders.
  • Also, we have begun collecting the existence of ancillary health consults on wards (Project AHC)

2. Update on Pneumonia, ventilator-associated (VAP)‎‎ coding

  • Lisa related that at the recent meeting of all data collectors, Jen presented the current VAP coding criteria, including the CDC 14-day blackout period for identifying subsequent pneumonias of any type
  • After discussion, we agreed to consider ECMO patients for VAPs -- this is relevant because CDC guidelines exclude that patient population.
  • The question arose about whether that 14 day rule should apply to bacterial superinfection of an initial viral pneumonia:
    • There is rationale for both doing and not doing this.
    • Before we make a final determination, Jen will perform a literature search about the frequency of such an event.
  • As the items contained in the "Recent Previous Pneumonia" segment of what is now on the VAP page (mainly the 14 day blackout rule) is relevant to all pneumonias, Tina will convert that to a template to be included in all the pneumonia Wiki pages
  • Jen will add some clarifying material to the 2nd primary bullet of the "Recent Previous Pneumonia" segment -- done

3. Should we categorize locations (dispo, previous locations, pre-admit) as general locations or as a specific location?

4. Add decubitus ulcer locations, request from SICU manager, Andie did a study evaluating the use of a new mepilex protective dressing. Her findings are as follows:

  • 6 months pre-trial n=27 with 12 non-coccyx ulcers
Total sacral/coccyx/buttock injuries- 15 
Stage 1	1
Stage 2	13
Stage 3	0
Stage 4	0
DTI	1

During/post 6 months (just missing November data at this time). n=13 with 10 or possible 7 non-coccyx ulcers 

Total sacral/coccyx/buttock injuries- 3 confirmed (however, 3 charts not reviewed yet…so could be up to 6)
Stage 1	 
Stage 2	 
Stage 3	1
Stage 4	 
DTI	1
Unstagable	1
    • Knowing the location long term will help us to track long term how we are doing without having to review every chart. While overall pressure injuries are good to know anecdotally, it doesn’t really give the big picture of if we are making an impact on the care. Especially since you are looking at the location anyways, does it hurt to record the area? Even a range of areas?
    • Our only tool currently to know locations etc is RL6 and we are quite certain that wounds are extremely underreported in RL.. I have not compared the data from the last year in RL vs these charts but I presume it will reflect this.
    • We also need to add DTI (deep tissue injury) as a new stage (ICD-10 dx)

5. Can we stop collecting past history of covid-19 infection (U07.5)? - Allan to email Bojan

6. Next meeting January 29 at 10 am CST

2024...

Also see Task Team Meeting - Rolling Agenda and Minutes 2024

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