Task Team Meeting - Rolling Agenda and Minutes 2020

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List of items to bring to task meeting

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Attribution of infections
  • Julie, the above question specifically affects some projects you work with as well - do you think unifying this rule will be a problem for any of them?


Does anyone think making this one rule for all will be a problem?

3 November 2019 19:41:06
CCI Volumes 2019There have been concerns about the volume of work generated by CCI entries. Since we had already reduced certain entries earlier in 2019, the numbers referenced here are only for pts admitted during the third quarter of 2019.4 December 2019 19:40:14
Can't check ICD10 ARF vs APACHE ARFIt used to be impossible to cross-check between dxs and ARF (APACHE) because of different definitions. With ICD10 now, and new definitions (Template:ICD10 Guideline KDIGO Guidelines for Acute Renal Failure), can we build a cross check that ARF (APACHE) can't be checked if pt has Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15? And further, would we be able to require that pt has (which) ARF dx in order to have ARF (APACHE) checked?22 September 2019 16:44:52
Coordination of data between collectorsz

We have discussed this at Task meeting and will tweak these instructions. Val is working on this, updates coming, just some working notes for now:

  • comparing admit/discharge times
  • sharing serials if that is still done anywhere, I think not... if anyone is still sharing a location and serial pool please post here...
  • "One more point, D5 & B3 use consecutive numbers also. These would be hard to keep track of without a paper log for the really quick admissions & discharges that are sometimes seen on B3.--CMarks 13:22, 2012 October 1 (CDT)"
14 November 2019 00:06:32
Definition of an ICU admissionThe following was written here, is it true? : For ICU patients collection starts at unit Arrive DtTm.
We need to update this to explicitly exclude ER pts. Yes, allegedly this "never happens", but since we explicitly exclude these, we should state so. This would also ensure consistency with pages like Length of Stay (ICU Report) which rely on this definition.
14 August 2019 00:30:23
Task Questions

Also see Task Team Meeting - Rolling Agenda and Minutes 2019

ICU Database Task Group Meeting – January 2, 2020

See Task Team Meeting - Rolling Agenda and Minutes 2019#ICU Database Task Group Meeting – December 11, 2019

  • Present: Allan, Barret , Joanna, Julie, Michelle, Tina, Trish
  • Absent:
  • Minutes prepared by: AG
  • Action items in BOLD

1. Followup about working to reduce collector workload

  • Regarding obtaining CBS TraceLine for all transfusion data. Allan will follow up with Margaret Ring (margaret.ring@blood.ca) and Tony Loewen (anthony.loewen@blood.ca)
  • Regarding obtaining RIS data for radiology tests. Allan will follow up with RIS administrators (Angela Charbonneau 926-9874; Randy Roels 926-9871, rroels@sharedhealth.mb.ca).
  • Regarding obtaining automated ABG data at HSC and St. B -- this has been implemented, getting that data from those sites from DSM data.
  • Regarding consolidating some of the “what was done” components of CCI therapeutic interventions -- the plans from the 11/11/2019 meeting have been implemented.

2. Followup on having the ICU nurses do all TISS coding -- we have not implemented this yet because:

  • While we have top administrator agreement at HSC, we are waiting for Dan to arrange similar meetings at St. B and Grace

3. Followup on trying to get hospital-level data elements from EPR. Tina discovered that there is an application called Cognos which has capability to extract data elements from existing databases.

4. Follow up on how to code diagnostic sampling of pericardial fluid or the pericardium. Answers are:

  • for therapeutic pericardial drainage combine (T) Pericardium with Drainage, Evacuation
  • for diagnostic pericardiocentesis -- we agreed today to add the “body part” item for diagnostic tests of 2.HA, (D) Pericardium. Then this is combined with the appropriate Biopsy (endoscopic) or Biopsy (non-endoscopic) depending how it was sampled. In other words, we are not distinguishing between a “fluid biopsy” of the pericardium and a true tissue biopsy of it. Tina added this.

5. Followup on pulling in certain lab results in addition to current counts vis re-parsing all DSM data from 1/1/2019

  • Barret with help from Tina will generate a draft list of which tests to do this for, which we’ll discuss at the next Task meeting. It should include the tests needed to calculate APACHE 2. Care must be taken to balance usefulness with data storage issues.
  • As part of this, we will work so that the labs values that are part of APACHE 2 no longer need to be dealt with by the data collectors.

6. Item we didn't discuss yet -- unconfirmed diagnoses with priority 0. We'll discuss next time.

7. Followup on query about coding for the myraid of other fistulas out there

  • There are separate codes for all of these when nontraumatic.
  • We already have codes for these: J95.03 for T-E, K31.6 for stomach or duodenum, K60.5 for anorectal, K63.2 for intestinal, N32.2 for bladder, N82 for female genital tract.
  • We don’t have codes now for: K82.3 for gallbladder, M25.1 for joint, or less common ones (e.g. lacrimal duct) and have to decide whether to add either of them. We also have to decide how to handle the fact that there are always TWO things connected by the fistula. We already have a “Category:Fistula” but probably need to create a template for it too that references the category but also discusses the various issues. If Tina will do this, Allan will populate it.

8. New items:

  • There is some uncertainty about what to do when in CCI, both diagnostic and therapeutic procedures are done on the same body part. We discussed this previously in the minutes, and under CCI Procedures it states when both are done to code them both.
  • How to code miscellaneous neuromuscular disorders?
    • This is problematic because although they are often discussed as if they were a single category of disorders, in fact they are two separate categories, comprising nervous system disorders and muscular disorders. This is why there is no ICD10 code for miscellaneous neuromuscular disorders.
    • The example used, Kennedy’s disease, also called “Spinal and bulbar muscular atrophy”, and is a degenerative disease of the CNS that results in muscle atrophy.
    • We already have sufficient “NOS” codes within the neuro and muscular disorders to handle this when the disorder is known but we don’t have a specific code for it (as in the Kennedy disease example, where one should use Degenerative nervous system disorder, NOS). The other potentially useful NOS codes are Muscle disorder/myopathy (primary or secondary), NOS and Disorder of nervous system (any part), NOS, and for when it’s a movement disorder Movement disorder, NOS.
    • The bigger problem is when it’s not clear whether it’s a primary nervous system vs. muscle disorder. In this case, one can:
      • wait to see whether the medical teams decide on nervous vs. muscular disorder
      • use a code that represents the symptom(s) not the disease per se. For example, if the symptoms are movement-related, one can use existing code Involuntary movements, NOS. And lastly when none of this is good enough, we might consider adding the code R29.8, to be called “Other and unspecified symptoms and signs involving the nervous and musculoskeletal systems”. We’ll discuss this next meeting.
  • Can ESRD be both and Admit and a Comorbid diagnosis? The answer is YES, if it was present prior to hospital admission AND it satisfies the criteria for an Admit diagnosis. This decision also answers the issue of having acute on chronic renal failure.
  • What should be done when creatinine clearance is <15 ml/min but the patient is admitted for uremic symptoms? This is an issue because the definition of Chronic kidney disease (end-stage renal/kidney disease, ESRD), Stage 5, GFR LT 15 is either on dialysis or with clearance<15. But of course, there are some patients who don’t start dialysis until they have GFR<10 or sometimes even lower. The answer is to follow the definition, such a person qualifies for Stage 5 as a comorbid condition, and as directly above, that same code can be used as an Admit diagnosis, along with the specific reason for admission (e.g. hyperkalemia).

ICU Database Task Group Meeting – December 11, 2019

See Task Team Meeting - Rolling Agenda and Minutes 2019#ICU Database Task Group Meeting – December 11, 2019