Difference between revisions of "Task Team Meeting - Rolling Agenda and Minutes 2021"

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Also see [[Task Team Meeting - Rolling Agenda and Minutes 2020]]
Also see [[Task Team Meeting - Rolling Agenda and Minutes 2020]]
== ICU Database Task Group Meeting – September 7, 2021 ==
*Present: Allan, Tina, Julie, Brynn, Lisa, Val, Mai, Pagasa, Joyce, Sherry, Mindy, Stephanie
*Minutes prepared by: AG
*Action items in BOLD
1.  Update on whether [[Transfer Ready DtTm tmp entry]] should be when first medically stable vs. once a decision has been made of where the person should go depends on the goal. 
*Allan reported that Medicine’s preference is to use when the patient is first identified (either in a progress note, or by an order) to be medically able to go to a lower level of care.  This makes it the same rule as for ICU.
2.  Update on new lab listings, which appear to duplicate prior listings.  '''Allan will contact somebody in the lab to clarify this issue'''.
3.  Update on question of how ICU desires reporting of: complications, outcomes, diagnoses, TISS, Transfer delays, mortality to each ICU.  Allan reports that he sent a followup email to Bojan, Kendiss and Carmen about what they want in this regards.  '''Reply as follows''':
*For all indicators (complications, outcomes, diagnoses, TISS, Transfer delays, and mortality) report by physical units, including patients admitted to ICU service but still in ED awaiting beds
**HSC MICU: MICU, JJ/JK, A7, PICU
**HSC SICU: SICU, PACU, MICU overflow
**HSC IICU: IICU, MS3 overflow
**Grace ICU: Grace ICU, PACU
**ACCU: ACCU, ACCU PACU overflow
**ICMS: ICMS, ICMS PACU overflow
**ICCS: ICCS, ICCS PACU overflow
**Exception would be PACU at St. Boniface where three services looked after their own patient separately.
4.  Continued discussion of how we record [[Transfer Ready DtTm tmp entry|Transfer Ready to a lower level of care date/time]], and use of [[:Category:Awaiting/delayed transfer | Awaiting/delayed transfer codes]].
*Tina/Julie showed that there have been a modest number of Awaiting/delayed codes used either as the admit diagnosis and/or as the Priority 1 diagnosis.  However, these are almost all prior to when we began the “patient follow” definition of database records. 
*Thus '''we decided, going forward, that the only only “Awaiting/delayed transfer” ICD10 codes we will continue using is [[Awaiting/delayed transfer to long-term care/PCH inside or outside of Winnipeg]]''' - '''Tina to fix wiki and data''
5.  A question arose relating to how collectors are paid.  Apparently, their payer has changed from WRHA to Shared Health and there is uncertainty and concern about this.  '''Allan will raise it with Roseanne and ensure it’s discussed at the upcoming Steering Committee meeting'''
6.  We revisited the issue, for Medicine wards only, of “splitting” CCI procedures on a day that a patient moves between different Medicine locations by entering a time into [[Px Date]].  After discussion we '''agreed that we do not need that level of information, and on Medicine we will no longer do so (though we will for ICU)'''.  We recognize that this means different rules about this for ICU vs. wards, but, given the workload associated with it, the data collectors greatly prefer this and do not think it will cause confusion among collectors who do both wards and ICU.  '''Sherry will fix this on the Wiki'''.
7.  Question arose of how to handle “missed MI”.  It was '''decided that it will be coded as an Acute MI if it is being actively treated'''. Lisa has updated the wiki
8.  Question arose about latent TB that is being treated, i.e. someone with a (+) skin or immunologic test for TB but no active organ involvement.  It was '''agreed to code it as [[Infectious disease NOS]] with [[Mycobacterium tuberculosis (M. TB)]] as the organism.'''
9.  Issue arose regarding if/how to ensure correctness of counts of reintubation/extubations ([[query check_CCI_TISS_Intubation_vs_Intubated]]).  It is complicated and '''Allan, Tina and Julie will meet to discuss the nuts and bolts of this'''. Tina has booked a meeting for Sep 22 for Allan, Julie and Tina.


== ICU Database Task Group Meeting – August 5, 2021 ==  
== ICU Database Task Group Meeting – August 5, 2021 ==  
Line 19: Line 54:
*Action items in BOLD
*Action items in BOLD


1.  Update on whether transfer ready date/time should be when first medically stable vs. once a decision has been made of where the person should go depends on the goal.  For example, it’d be the former for the Overstay project, while it’d be the latter to count actual “excess days”.   
1.  Update on whether [[Transfer Ready DtTm]] should be when first medically stable vs. once a decision has been made of where the person should go depends on the goal.  For example, it’d be the former for the [[Overstay]] project, while it’d be the latter to count actual “excess days”.   
*'''Allan reports that he will send a followup email to Drs. Hajadiacos, Griffin and Renner when they all return to town late in August'''.
*'''Allan reports that he will send a followup email to Drs. Hajadiacos, Griffin and Renner when they all return to town late in August'''.


2.  Update on new lab listings, which appear to duplicate prior listings.  '''Allan will contact somebody in the lab to clarify this issue'''.
2.  Update on new [[DSM Lab Extract]] lab listings, which appear to duplicate prior listings.  '''Allan will contact somebody in the lab to clarify this issue'''.


3.  Update on question of how ICU desires reporting of: complications, outcomes, diagnoses, TISS, Transfer delays, mortality to each ICU.  Allan reports that he sent a followup email to Bojan, Kendiss and Carmen about what they want in this regards.  '''Awaiting reply'''.   
3.  Update on question of how ICU desires reporting of: complications, outcomes, diagnoses, TISS, Transfer delays, mortality to each ICU.  Allan reports that he sent a followup email to Bojan, Kendiss and Carmen about what they want in this regards.  '''Awaiting reply'''.   
Line 31: Line 66:
*So we '''agreed that:  We will try, completing older records from oldest to newest, while starting moving forwards at full speed.  We will re-evalute this plan after a couple of months.'''
*So we '''agreed that:  We will try, completing older records from oldest to newest, while starting moving forwards at full speed.  We will re-evalute this plan after a couple of months.'''


5.  Continued discussion of how we record Transfer Ready to a lower level of care date/time.
5.  Continued discussion of how we record Transfer Ready to a lower level of care date/time ([[Change from Awaiting/delayed dx codes to Transfer Ready DtTm]]).
*To this point, reporting has combined “wasted days” for Medicine Ward and Hi-obs together.  '''From now on it will report wasted days separately by level, i.e. for:  ICU, IICU, Hi-obs, Wards.'''
*To this point, reporting has combined “wasted days” for Medicine Ward and Hi-obs together.  '''From now on it will report wasted days separately by hospital and by level, i.e. for:  ICU, IICU, Hi-obs, Wards.'''
*'''We will no longer have collectors identify the expected lower level location.'''
*'''We will no longer have collectors identify the expected lower level location.'''
*'''After re-evaluation, the only “Awaiting/delayed transfer” ICD10 codes we will continue using is: Z75.4 Awaiting/delayed transfer to long-term care/PCH'''
*'''After re-evaluation, the only “Awaiting/delayed transfer” ICD10 codes we will continue using is: Z75.4 [[Awaiting/delayed transfer to long-term care/PCH inside or outside of Winnipeg]]
{{Discuss |
'* What if awaiting code is primary reason? Sent Allan an email with counts about this. [[User:Ttenbergen|Ttenbergen]] 14:03, 2021 August 26 (CDT) }}


6.  Item from prior meeting between Allan and Tina --- '''Allan to contact Don Thiessen to try and obtain ability of collectors to access the Service History on EPR.'''
6.  Item from prior meeting between Allan and Tina --- '''Allan to contact Don Thiessen to try and obtain ability of collectors to access the Service History on EPR.'''

Latest revision as of 09:48, 2021 September 22

List of items to bring to task meeting

Add to this by adding the following to the article where the problem is documented:

{{DiscussTask | explanation}}
 QuestionModification date"Modification date" is a predefined property that corresponds to the date of the last modification of a subject and is provided by Semantic MediaWiki.
Acquired Diagnosis / Complicationthis relates to Attribution of infections and we need to be sure to have it consistent.
Como Admit Acquired Primary Limits - this is part of that discussion - if we limit which admits will count as comos we need to review
Rules 1 and 2 are clear, could rule 3 be further clarified
1 April 2021 17:05:28
Admit Type for APACHE II
  • at some point we went through a thorough definition of this at Emergency Surgery (concept) - should we refer to that, or keep this reduced definition? Ttenbergen 17:09, 2021 April 22 (CDT)
2 September 2021 14:35:31
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
Change from Awaiting/delayed dx codes to Transfer Ready DtTmChange on hold until discussed.15 July 2021 17:19:57
Change to replace Accept DtTm with first Service tmp entry, and Arrive DtTm with first Boarding LocIs there a target date for eliminating this field? Ttenbergen 15:10, 2021 April 15 (CDT)2 September 2021 19:39:10
Cognos2 No Service or Loc in some time query
  • Are people using this? Would it be worth having a button to open the record directly from the query screen? Would take about 30 min to set up...
4 August 2021 01:18:39
Definition of a Medicine Laptop Admission 5 August 2021 13:44:57
HSC Boarding Locations
  • With Cognos, we would no longer capture boarding patients by looking at a location. So, is there any value in having this page? Is it being kept updated? Ttenbergen 09:48, 2021 September 2 (CDT)
2 September 2021 14:48:39
Height and weightZ) decided to revisit SOFA scoring 6 months after ICD10 so same should likely go for this.26 January 2019 01:38:46
Public Entrance Likely Initial PageAJTT
  • Should we have a plan to review these regularly since they are front page linked, or are we OK with them being unmaintained? Or should we delete them altogether?
11 March 2021 16:13:29
Query check CCI TISS Dxs vs Dialysis1 Should discuss if this is even a good cross check.8 September 2021 16:33:16
SOFA scoringZ) decided to revisit 6 months after ICD1018 July 2019 19:24:46
Sending Patients
  • I just came across over 200 sent patients on a laptop data that had been sent and not been deleted; I have not systematically checked the situation on other laptops. We are only supposed to have currently active records on the laptops. Our documentation of this is not completely clear, it just says you can but should not, but gives no further guidance. On the laptop I reviewed almost half the total records were of sent patients, and if the "last opened" dates are right some had not been touched since March, which is definitely more than I had figured when I last read that on wiki. What would be a reasonable but tighter guideline for how long send records can be kept and how they should be managed? Ttenbergen 09:58, 2021 May 13 (CDT)
13 May 2021 14:58:30
Spontaneous breathing via ETT without PEEP/CPAP, with or without supplemental O2 (TISS Item)
  • we changed the name of this, but we are not actually collecting it right now. Do we really want to start to collect it again?
  • the original had 2 points (as per info box), will it really change to 1?
1 September 2021 21:30:05
Swap Locations
  • Another option, and this seems to be what is being done now, is for collectors to "exclude" unit lines from Cognos that list "wrong" start or end times because part of the time is in a swap location.


  • One option would be to omit lines with current unit is a swap location from the cognos data via filter automatically, but it's not clear if this will result in the previous and subsequent records having non-matching next locations and previous locations. Can we just delete these lines from Cognos? Ttenbergen 14:03, 2020 August 28 (CDT)


One problem with filtering these out would be that, I think, the unit record for a swap location might be the same as the unit record for a successive stay in that unit; ie. the bed entry chagnes, but the unit remains the same. So, the unit start dttm and unit end dttm don't care if part of the unit stay was in a swap location. Is that not true? If it is true, then how would we filter these out? if I eliminate every line that has a swap/swing bed (which I can do) then we will not get any line for those pts who never get into a real bed on that unit (which may be good), but we would still get the same line with unit start and end times including the swap/swing time for patients who eventually get into a bed on that unit. Ttenbergen 12:07, 2020 December 2 (CST)

  • Would it make sense to talk to STB about how the swing beds are used by ER? I don't think talking to anyone about how the swing beds are used by er would be helpful. I've explained in great detail a number of times, to a number of people why this occurs. I can't think of anything different that could potentially be done to work around the issue as it occurs in the first place. DPageNewton 10:59, 2020 December 3 (CST)


  • Debbie: When you say "the next entry in the location history", you mean the history on the EPR, right? Ttenbergen 09:26, 2020 December 3 (CST)
    • Yes, the location history in the epr. Each scenario with a swing bed entry can be different, and needs to be reviewed to ascertain the true and correct information. DPageNewton 09:45, 2020 December 3 (CST)


  • Is there ever "room for interpretation" where both collectors would still consider the pt on their unit, or where both would consider them already/still on the other unit? If not, how and why?
    • I don't think there is room for "interpretation" as the entry for the "swing bed" is simply ignored, as if it weren't there. We at St. B. have been dealing with this issue since the beginning of time. DPageNewton 10:59, 2020 December 3 (CST)


  • Allan, Julie and Tina had discussed this at a different meeting and decided we should just collect the swing beds as if they were already on the unit. The assumption was that they would only be in a swing bed for a few hours at most.
    • Stephanie pointed out that some of the cardiac pts are listed as in a swing bed for the whole duration of their OR stay (whereas others are listed as in OR). So it appears that the amount of time pts spend in swing beds can be considerable.
      • We decided to hold off on this discussion and bring it forward at the next task meeting which is Dec 16. Ttenbergen 11:28, 2020 December 8 (CST)


  • I supposed this swing bed is already happening in the past, before we have this COGNOS admitter. How it is handle? 1) is it included – such that the accept date is taken from that line of swing bed or 2) excluded and the next line where the Accommodation has an entry is the one chosen? I think we need to decide first if to include or not before solving the exclusion process. who to ask? --JMojica 16:02, 2020 December 2 (CST) we do 2)
    • excluded and the next line where the Accommodation has an entry is the one chosen? DPageNewton 10:59, 2020 December 3 (CST)
  • Absolutely agreed, Julie. But there is also an element of us reporting info different than maybe what other, EPR based reports would show. #"Swing beds" at STB shows the list of swing bed locations that show up in the Cognos data. They all are associated by name and data to the ward locations. So anyone generating data from EPR/Cognos would associate these with the units, not the previous location. We would be the only place associating them with still being in the ER. I just reviewed the raw Cognos data, and we get the bed, but not the bed start and end dttm. If we could get that we would be able to figure out what percentage of total LOS is affected by this, but it probably has the biggest impact on ER wait times
    • in the example I gave above, yes the er wait time is what would be affected. DPageNewton 10:59, 2020 December 3 (CST)
      • It sounds like anyone just looking at Cognos data would underestimate that time because pts look like they are on unit already. Ttenbergen 09:56, 2020 December 3 (CST)
        • I've spoken with the ward clerks on E5 on more than one occasion, and have been told, that when there is a swing bed entry for example, between an er location, and a ward location, the patient is still physically in the er, and has not been transferred up to the ward. e.g. #2-if the swing bed location is between say, E5, and another usual ward or unit location, then the patient is still physically on E5. In this example the los for E5 would be affected. I think that this is a concept that is not so easy to explain in words, especially if you're not particularly familiar with the ins and outs of epr. DPageNewton 10:59, 2020 December 3 (CST)
7 September 2021 15:42:46
Transfer Delay (Critical Care)
  • I don't quite understand this. Does it mean that, for whatever report uses this, it only considers the TRDtm+4hrs?


  • Multiple ward/unit stays are now in one profile. What will Transfer Delay mean, will it be from the first time the pt is ready (ie one per profile) or one for each Boarding Loc? Once we settle the details we should implement this in CFE so it can be derived without the use of SAS.
    • Luckily this didn't happen on first round of reporting. We need to discuss at Task how collectors actually collect this. And then also how we would want to report this, by profile or by Boarding Loc. Because we can't really report it by service.
22 July 2021 21:30:02
Transfer Ready DtTm tmp entry 5 August 2021 16:35:34

Also see Task Team Meeting - Rolling Agenda and Minutes 2020

ICU Database Task Group Meeting – September 7, 2021

  • Present: Allan, Tina, Julie, Brynn, Lisa, Val, Mai, Pagasa, Joyce, Sherry, Mindy, Stephanie
  • Minutes prepared by: AG
  • Action items in BOLD

1. Update on whether Transfer Ready DtTm tmp entry should be when first medically stable vs. once a decision has been made of where the person should go depends on the goal.

  • Allan reported that Medicine’s preference is to use when the patient is first identified (either in a progress note, or by an order) to be medically able to go to a lower level of care. This makes it the same rule as for ICU.

2. Update on new lab listings, which appear to duplicate prior listings. Allan will contact somebody in the lab to clarify this issue.

3. Update on question of how ICU desires reporting of: complications, outcomes, diagnoses, TISS, Transfer delays, mortality to each ICU. Allan reports that he sent a followup email to Bojan, Kendiss and Carmen about what they want in this regards. Reply as follows:

  • For all indicators (complications, outcomes, diagnoses, TISS, Transfer delays, and mortality) report by physical units, including patients admitted to ICU service but still in ED awaiting beds
    • HSC MICU: MICU, JJ/JK, A7, PICU
    • HSC SICU: SICU, PACU, MICU overflow
    • HSC IICU: IICU, MS3 overflow
    • Grace ICU: Grace ICU, PACU
    • ACCU: ACCU, ACCU PACU overflow
    • ICMS: ICMS, ICMS PACU overflow
    • ICCS: ICCS, ICCS PACU overflow
    • Exception would be PACU at St. Boniface where three services looked after their own patient separately.

4. Continued discussion of how we record Transfer Ready to a lower level of care date/time, and use of Awaiting/delayed transfer codes.

  • Tina/Julie showed that there have been a modest number of Awaiting/delayed codes used either as the admit diagnosis and/or as the Priority 1 diagnosis. However, these are almost all prior to when we began the “patient follow” definition of database records.
  • Thus we decided, going forward, that the only only “Awaiting/delayed transfer” ICD10 codes we will continue using is Awaiting/delayed transfer to long-term care/PCH inside or outside of Winnipeg' - Tina to fix wiki and data

5. A question arose relating to how collectors are paid. Apparently, their payer has changed from WRHA to Shared Health and there is uncertainty and concern about this. Allan will raise it with Roseanne and ensure it’s discussed at the upcoming Steering Committee meeting

6. We revisited the issue, for Medicine wards only, of “splitting” CCI procedures on a day that a patient moves between different Medicine locations by entering a time into Px Date. After discussion we agreed that we do not need that level of information, and on Medicine we will no longer do so (though we will for ICU). We recognize that this means different rules about this for ICU vs. wards, but, given the workload associated with it, the data collectors greatly prefer this and do not think it will cause confusion among collectors who do both wards and ICU. Sherry will fix this on the Wiki.

7. Question arose of how to handle “missed MI”. It was decided that it will be coded as an Acute MI if it is being actively treated. Lisa has updated the wiki

8. Question arose about latent TB that is being treated, i.e. someone with a (+) skin or immunologic test for TB but no active organ involvement. It was agreed to code it as Infectious disease NOS with Mycobacterium tuberculosis (M. TB) as the organism.

9. Issue arose regarding if/how to ensure correctness of counts of reintubation/extubations (query check_CCI_TISS_Intubation_vs_Intubated). It is complicated and Allan, Tina and Julie will meet to discuss the nuts and bolts of this. Tina has booked a meeting for Sep 22 for Allan, Julie and Tina.

ICU Database Task Group Meeting – August 5, 2021

  • Present: Allan, Tina, Julie, Brynn, Pam, Lisa, Val
  • Minutes prepared by: AG
  • Action items in BOLD

1. Update on whether Transfer Ready DtTm should be when first medically stable vs. once a decision has been made of where the person should go depends on the goal. For example, it’d be the former for the Overstay project, while it’d be the latter to count actual “excess days”.

  • Allan reports that he will send a followup email to Drs. Hajadiacos, Griffin and Renner when they all return to town late in August.

2. Update on new DSM Lab Extract lab listings, which appear to duplicate prior listings. Allan will contact somebody in the lab to clarify this issue.

3. Update on question of how ICU desires reporting of: complications, outcomes, diagnoses, TISS, Transfer delays, mortality to each ICU. Allan reports that he sent a followup email to Bojan, Kendiss and Carmen about what they want in this regards. Awaiting reply.

4. We discussed the COVID-related backlog in completing data collection.

  • Julie shows us that: Up to and including 3/2021, we have only 28 charts to complete; Thereafter there are several hundred per month.
  • After discussion, both the ICU and Medicine data collectors believe that after the seconded collectors return, we WILL be able to catch up.
  • So we agreed that: We will try, completing older records from oldest to newest, while starting moving forwards at full speed. We will re-evalute this plan after a couple of months.

5. Continued discussion of how we record Transfer Ready to a lower level of care date/time (Change from Awaiting/delayed dx codes to Transfer Ready DtTm).

  • To this point, reporting has combined “wasted days” for Medicine Ward and Hi-obs together. From now on it will report wasted days separately by hospital and by level, i.e. for: ICU, IICU, Hi-obs, Wards.
  • We will no longer have collectors identify the expected lower level location.
  • After re-evaluation, the only “Awaiting/delayed transfer” ICD10 codes we will continue using is: Z75.4 Awaiting/delayed transfer to long-term care/PCH inside or outside of Winnipeg
Interro-01.gif

'* What if awaiting code is primary reason? Sent Allan an email with counts about this. Ttenbergen 14:03, 2021 August 26 (CDT)

  • SMW


  • Cargo


  • Categories

6. Item from prior meeting between Allan and Tina --- Allan to contact Don Thiessen to try and obtain ability of collectors to access the Service History on EPR.

7. Next meeting Sept 7, 2021 at 11 am.

ICU Database Task Group Meeting – July 8, 2021

  • Present: Allan, Tina, Julie, Mailah, Pam, Lisa
  • Minutes prepared by: AG
  • Action items in BOLD

1. Update on whether transfer ready date/time should be when first medically stable vs. once a decision has been made of where the person should go depends on the goal. For example, it’d be the former for the Overstay project, while it’d be the latter to count actual “excess days”.

  • Allan reports that he’s still awaiting a reply about this from Nick Hajadiacos.

2. Update on new lab listings, which appear to duplicate prior listings. Allan will contact somebody in the lab to clarify this issue.

3. Update on question of how ICU desires reporting of: complications, outcomes, diagnoses, TISS, Transfer delays, mortality to each ICU. Allan reported the he, Julie, Bojan, Kendiss and Carmen had a ZOOM call about this and the status is that the latter 3 want to cogitate about this before deciding. Allan will followup with them within the next 2 weeks.

4. Lost/missing chart: Following up on a further details of dealing with charts that are missing in medical records for a long time, the question arose of if/how to code the APACHE components. After discussion we agreed that instead of the typical rule to code missing APACHE elements as “normal”, to instead code these with a missing data code = -999. Allan added this to the Wiki page for Lost/missing chart.

5. Followup on TISS item#20 = “Supplemental oxygen without ETT or trach”. See item#7 from June 15 minutes.

  • After discussion we agreed to fix the problem we’ve had all along with our implementation of TISS 28, that relates to coding of supplemental oxygen via trach mask. Specifically:
    • O2 by trach mask is supposed to be, like all supplemental oxygen other than that with mechanical ventilation, a 2 point score. However we have included it incorrectly, as our current TISS codes related to trach and supplemental O2 are:
      • (19) Spontaneous breathing via ETT or trach (no ventilator attached)
      • (20) Supplemental oxygen without ETT or trach (nasal prongs or face mask)
    • That is it currently will be coded as TISS#19 for 1 point, while it is supposed to be in TISS#20 for 2 points.
  • Going forward, we will alter TISS items #19 and #20 to read as follows:
    • new 19 = Spontaneous breathing via ETT without PEEP/CPAP, with or without supplemental O2 -- e.g. includes trach mask, T-tube. This is 1 point.
    • new 20 = Supplemental O2 though any device, delivered via nose, mouth, ETT or trach. This is 2 points.
  • Lisa will make these changes in the Wiki and also email all collectors about this change.

6. Question arose of whether/how to code stroke as a comorbid, and whether it should be different if there are versus are not long-term sequelae. This is particularly relevant as our usual guideline for coding of comorbids is to NOT do so if there are no sequelae. After discussion we agreed that this will be an exception and past history of stroke will be included as a comorbid even if there are no sequalae. Lisa made this change in Template:ICD10 Guideline Stroke resolved exception, and will email all collectors about this change.

7. Postal Code field - We have recently recognized that there can be confusion in COGNOS about the patient’s current postal code. As we have little confidence that this will be fixed between ADT and COGNOS, we decided that our rule for postal codes will be to obtain them from the EHR rather than COGNOS. Tina has updated Postal_Code_field#Don.27t_trust_Postal_Codes_from_Cognos.

8. Next meeting August 5, 2021 at 11am.

ICU Database Task Group Meeting – June 15, 2021

  • Present: Allan, Tina, Julie, Stephanie, Sherry, Mailah, Brynn, Lisa
  • Minutes prepared by: AG
  • Action items in BOLD

1. Update on duplication between Transfer Ready DtTm tmp entry and the set of codes listed under. See item#2 in prior minutes for details.

  • Tina will implement these changes July 1, 2021; Tina forgot so just implemented today, Jul 8

2. Update on whether transfer ready date/time should be when first medically stable vs. once a decision has been made of where the person should go depends on the goal. For example, it’d be the former for the Overstay project, while it’d be the latter to count actual “excess days”.

  • Allan reports that he’s awaiting a reply about this from Nick Hajadiacos/Paddy Griffin/Ebi Renner

3. Update on new lab listings, which appear to duplicate prior listings. Allan will contact somebody in the lab to clarify this issue.

4. Update on question of how ICU desires reporting of: complications, outcomes, diagnoses, TISS, Transfer delays, mortality to each ICU. To address this, Allan is trying to schedule a ZOOM call including: Julie, Bojan, Kendiss/Carmen, Allan.

5. Lost/missing chart: Details of when/how to deal with charts that are missing in medical records for a long time. After discussion we agreed that we will: (a) consider a chart as missing 6 months (or 180 days) after hospital discharge, (b) we will assign such records as “Discontinued”, (c) Pagasa will deal with these in an ad hoc manner, and (d) Allan has altered Lost/missing chart to reflect all this.

6. Regarding the Minimal Data Set, we will include in it the initial Boarding Loc and initial Service tmp entry. Tina has updated the wiki page.

7. Regarding TISS item#20 = “Supplemental oxygen without ETT or trach”

  • This item does not appear to include supplemental O2 via trach mask, and the question was whether we do/don’t want to capture that. Allan went go back to the original TISS description to find out. The original listings in the respiratory support category were:
    • (A) Mechanical ventilation = any form of mechanical/assisted ventilation with or without PEEP, including spontaneous breathing with PEEP (via ETT, trach, nasal mask, full facemask, full head hood, etc). 5 points.
    • (B) Supplementary ventilatory support = breathing spontaneously through ETT without PEEP; supplemental O2 by any method except if mechanical ventilation applies. 2 points.
    • (C) Presence of ETT or tracheostomy. 1 point.
    • (D) Treatment for improving lung function = any of chest physiotherapy, incentive spirometry, tracheal suctioning or inhalational therapy. 1 point.
  • We note that we have done some subdivision of these to provide more detailed information, specifically:
    • (18) Invasive mechanical ventilation via ETT or trach (AC, SIMV, PSV)
    • (19) Spontaneous breathing via ETT or trach (no ventilator attached)
    • (20) Supplemental oxygen without ETT or trach (nasal prongs or face mask)
    • (21) Non-invasive CPAP or BIPAP (nasal or face mask)
    • (22) ETT present
    • (23) Tracheostomy tube present
    • (24) Chest physio (pummeling and/or vibes and/or DB&C)
    • (25) Incentive spirometry
    • (26) Inhalation therapy (nebulizers, puffers)
    • (27) Intratracheal suctioning (via ETT, trach, nasal trumpet, oral)
  • Mappings of the original TISS-28 categories to our current categories are as follows:
    • A = 18 or 21. 5 points.
    • B = 19 or 20 BUT does not map perfectly to 19 or 20. 2 points.
    • C = 22 or 23. 1 point.
    • D = 24 or 25 or 26 or 27. 1 point.
  • THUS, we have a problem related to the mapping of B with 19/20 -- i.e. “spontaneous breathing via trach without supplemental O2” is currently included in #19 and maps to ‘B’ (2 points) but should be omitted from #19 and instead just be part of #23 (‘C’) and thus 1 point. To match the original description of ‘B’, we could alter 19 and 20 as follows:
    • Altered 19 = Spontaneous breathing via ETT without PEEP/CPAP, with or without supplemental O2 -- e.g. includes trach mask, T-tube
    • Altered 20 = Supplemental O2 though any device, delivered via nose, mouth, ETT or trach
    • We will discuss this at the next meeting.

8. Regarding the field identifying if a patient was sedated during GCS measurement.

  • Julie indicated that this field is entirely unused. In light of that Tina has removed the field from CCMDB.accdb as of v2021-06-15.

9. Regarding an issue with John/Jane Doe in our patient follow model:

  • The issue is that once the person is identified, he/she then appears in ADT records as a “new” patient with a new MRN.
  • After discussion we recognized that the same ClientVisitGUID is used, and that using THIS is the fix to the problem. Tina/Julie to make needed changes to deal with this issue; Tina started the change, work in progress.

10. Next meeting July 8, 2021 at 11 am.

ICU Database Task Group Meeting – June 3, 2021

  • Present: Allan, Tina, Julie, Pam, Lisa, Mailah, Mindy, Brynn, Sherry
  • Minutes prepared by: AG
  • Action items in BOLD

1. Update on removing ideas/codes for “potential infection”, and “Not an infection”. Tina to update this information on the wiki and remove those codes from use.

2. NOTE: This item was discussed on May 19, 2021, but until today Allan failed to include it in those minutes. The item read:

  • We realized that there is unwanted duplication between Transfer Ready DtTm tmp entry and the set of codes listed under Category:Awaiting/delayed transfer.
    • After discussion we agreed to get rid of all the Category:Awaiting/delayed transfer codes and instead to augment the information we collect from each Boarding Loc. Specifically, if in a given location the patient is deemed transfer ready to a lower level of care, then the data collectors will indicate the time/date of that transfer-readiness, and now also choose from a dropdown list the type of lower level of care location to which the person can go to.
    • This list will be:
      • If they’re in an ICU: ICU outside of WRHA; IICU; WRHA HOB Medicine Ward; WRHA non-Medicine HOB/stepdown; WRHA non-Medicine ward; ward outside WRHA; LTC/PCH; Home;
      • If they’re in IICU: WRHA HOB Medicine Ward; WRHA non-Medicine HOB/stepdown; WRHA non-Medicine ward; ward outside WRHA; LTC/PCH; Home
      • If they’re in a Medicine ward: non-Medicine ward in WRHA; ward outside WRHA; LTC/PCH; Home
  • TODAY we had a discussion that expanded on this issue, particularly relevant to medicine ward data:
    • Whether the transfer ready date/time should be when first medically stable vs. once a decision has been made of where the person should go depends on the goal. For example, it’d be the former for the Overstay project, while it’d be the latter to count actual “excess days”.
    • Also, if it once medically stable for transfer, it sometimes takes 1-few days for PT and OT to do a home safety evaluation and thus for there to be a decision of the location to which the transfer should occur (e.g. home vs. PCH).
    • To clarify these issues, Allan will communicate with Nick Hajadiacos.

3. Discussion about whether to continue the current paradigm of having a single record encompassing direct ICU-to-ICU transfers.

  • Julie pointed out several things:
    • There have been just 8 MICU-SICU transfers since October 2020. However, it was observed that this small number may reflect the (hopefully temporary) changes due to COVID-19.
    • The concept behind the current paradigm (i.e. attempting to include a complete episode of ICU care within each ICU record) really currently only takes account of HSC MICU/SICU. Allan reminded the group that this was meant to be a first step and that we need to revisit expanding that paradigm to ICU-to-ICU transfers between different hospitals.
    • It took about 1 month to modify all her data reporting programs to deal with this change. This is all done now.
  • Further discussion identified that there continue to be issues in reporting what is desired by our data users vs. what we provide vs. what makes sense, when patients move between ICU locations (including boarding locations) and/or between ICU services. Issues include:
    • Differences between reporting specific to ICU locations vs. ICU services
    • For each reported parameter, we need to clarify the best way to “assign”: complications, outcomes, diagnoses, TISS, Transfer delays, mortality to each ICU. To address this, Allan will work on scheduling a ZOOM call including: Julie, Bojan, Kendiss/Carmen, Allan.

4. Julie highlighted that there are new lab tests coming in with the DSM data. Allan will review them.

5. Following up regarding identification of boarding locations -- see item#3 in April 15 minutes

  • Because it is less work for the DCs (since they come directly from COGNOS), we have decided to use the detailed boarding locations rather than more general listings (e.g. HSC-Medicine).
  • Tina to implement this for St B and HSC -- but will wait for a new manager to be hired.

6. Followup on trying to get hospital-level data elements from EPR -- this is awaiting a solution about database hosting.

7. Followup about working to reduce collector workload. Things that need to be done:

  • Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
  • Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
  • Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].

8. Next meeting Tuesday June 1, 2021 at 11am.

ICU Database Task Group Meeting – May 19, 2021

  • Present: Allan, Tina, Barret, Julie, Pam, Val, Joyce, Sherry, Lisa, Mailah
  • Minutes prepared by: AG
  • Action items in BOLD

1. Following up regarding identification of boarding locations -- see item#3 in April 15 minutes

  • Because it is less work for the DCs (since they come directly from COGNOS), we have decided to use the detailed boarding locations rather than more general listings (e.g. HSC-Medicine).
  • Tina to implement this for St B and HSC.

2. Update on removing ideas/codes for “potential infection”, and “Not an infection”. Tina still to update this information on the wiki and remove those codes from use.

3. Many physicians are referring to lung abnormalities after COVID as “post-COVID pneumonia” or “post-COVID pneumonitis”. Discussion highlighted the fact that the vast majority of these changes are NOT infectious at all, and represent rather some combination of ongoing noninfectious inflammation and fibrosis. Allan has modified the Post COVID-19 condition to reflect this, and liked to it in COVID-19 (SARS-COV-2).

4. We realized that there is unwanted duplication between Transfer Ready DtTm tmp entry and the set of codes listed under Category:Awaiting/delayed transfer.

  • After discussion we agreed to get rid of all the Category:Awaiting/delayed transfer codes and instead to augment the information we collect from each Boarding Loc. Specifically, if in a given location the patient is deemed transfer ready to a lower level of care, then the data collectors will indicate the time/date of that transfer-readiness, and now also choose from a dropdown list the type of lower level of care location to which the person can go to.
  • This list will be:
    • If they’re in an ICU: ICU outside of WRHA; IICU; WRHA HOB Medicine Ward; WRHA non-Medicine HOB/stepdown; WRHA non-Medicine ward; ward outside WRHA; LTC/PCH; Home; ??????
    • If they’re in IICU: WRHA HOB Medicine Ward; WRHA non-Medicine HOB/stepdown; WRHA non-Medicine ward; ward outside WRHA; LTC/PCH; Home
    • If they’re in a Medicine ward: non-Medicine ward in WRHA; ward outside WRHA; LTC/PCH; Home

5. Question about when along the process of readying a patient for transfer home to deem the patient transfer-ready. Specifically, the sequence of events is: home safety evaluation by PT and OT ---> if cleared for home, then homecare evaluation prior to discharge.

  • It was decided that in this situation we will consider the transfer ready date/time to be AFTER the patient has passed the home safety evaluation, but before homecare evaluation has occurred. The rationale is that homecare evaluation can occur after discharge, but a hospitalized patient who “fails” their home safety evaluation will end up going to LTC, not home. Allan added this to the Transfer Ready DtTm tmp entry wiki page.

6. Question arose about procedure time recording for Ward patients, on a day when the patient moves between two boarding locs. After discussion, we agreed to handle this just as for an ICU patient.

7. Regarding disposition date/time. The question was whether this should be the ending time in Cognos for the service or final location, as these can be different. We agreed to Tina’s suggestion to use the service end time, as it causes less problems.

8. Followup on trying to get hospital-level data elements from EPR -- this is awaiting a solution about database hosting.

9. Followup about working to reduce collector workload. Things that need to be done:

  • Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
  • Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
  • Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].

10. Next meeting June 3 at 11am. At that meeting we must discuss confusion about using COGNOS to identify new records.

11. Followup on trying to get hospital-level data elements from EPR.

  • Allan provided Bojan/Ebi with a written explanation of what is being requested -- we need to followup on this item.

12. Followup about working to reduce collector workload. Things that need to be done:

  • After the COVID emergency passes, Allan to talk with Medicine leadership (including Ebi, Nick, Mary Anne, others) about precisely what information they need/want reported for Medicine ward patients within each hospital. The issue here is whether, within each hospital, they really need to distinguish data by ward, or by teaching vs. nonteaching.
  • Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
  • Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
  • Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].

ICU Database Task Group Meeting – April 22, 2021

  • Present: Allan, Tina, Barret, Pam, Julie, Pam, Val, Mindy
  • Minutes prepared by: AG
  • Action items in BOLD

1. Following up regarding identification of Boarding Locs -- see item#3 in April 15 minutes

  • Because it is less work for the DCs (since they come directly from COGNOS), we have decided to use the detailed boarding locations rather than more general listings (e.g. HSC-Medicine).
  • Tina to implement this for St B and HSC

2. Allan made changes to Definition of a Critical Care Laptop Admission Wiki page regarding if/when the ICU team takes over a patient during a ward code -- Val to look it over and see if it makes sense

3. More discussion around Boarding Loc, Service tmp entry

  • After discussion we agreed that we will ensure that the first boarding location date/time will equal the first service date/time
    • Currently, this is being done for ICU transfers from ward, but not for patients who are taken over in ED by Medicine or ICU.
    • Allan fixed this on the Boarding Loc wiki page.
    • Tina has implemented a laptop crosscheck to make sure of this.

4. At HSC and St. B there are frequent service switches back and forth on wards between the Teaching and Non-teaching services. These are delineated in COGNOS and therefore if the DCs copy this information over from COGNOS to Service tmp entry this level of detail is recorded. The question arose of whether we need/want this level of detail.

  • The answer is No, but since it is easier for the DCs to just accept this information from COGNOS than to figure out the teaching/nonteaching issues, and since Julie can do the needed reporting whichever choice is made, we agreed that we will leave it as is and have the DCs input this level of (unneeded) detail from COGNOS.

5. More discussion about the Transfer Ready DtTm tmp entry timing that goes along with each Boarding Loc entry

  • We heard from some DCs that it is common that a ward patient is transferred (e.g. home) without any notes stating the team’s intention to do so in advance of that actually happening or even an order to discharge. And that the DCs attempt to make educated guesses from the notes of when the patient was probably clinically ready to leave to a lower level of care.
  • Recognizing that such a judgement is likely to be highly variable, we agreed that from now on DCs will not try to make such judgements. Thus, they will record a transfer ready date/time if one is clear (from a discharge order, or a progress note), but in the absence of such a clear indication, for those who left the ward alive, the transfer ready date/time will be recorded as the actualy discharge date/time. Allan fixed the Wiki page on this.

6. Follow up regarding modifying the laptop input of Transfer Ready DtTm tmp entry for each boarding location:

  • Tina still to work with Julie and Sherry to make this data input less confusing.

7. Follow up regarding how to code a medicine patient boarding in CAU -- Tina still to make the change indicating that we will not code CAU as a separate boarding location, but include it in with Ward boarding locations.

8. Followup on trying to get hospital-level data elements from EPR.

  • Allan provided Bojan/Ebi with a written explanation of what is being requested -- we need to followup on this item.

9. Followup about working to reduce collector workload. Things that need to be done:

  • After the COVID emergency passes, Allan to talk with Medicine leadership (including Ebi, Nick, Mary Anne, others) about precisely what information they need/want reported for Medicine ward patients within each hospital. The issue here is whether, within each hospital, they really need to distinguish data by ward, or by teaching vs. nonteaching.
  • Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
  • Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
  • Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].

ICU Database Task Group Meeting – April 15, 2021

  • Present: Allan, Tina, Barret, Julie, Lisa, Pam, Pagasa, Val, Mailah, Brynn
  • Minutes prepared by: AG
  • Action items in BOLD

1. Regarding the APACHE II comorbidities:

  • We confirmed the ICD-10 codes from the 3/24/2021 meeting
  • After further consideration we decided to implement the drug-induced immunosuppression portion of the immunocompromise comorbidity as a TISS element rather than as an ICD-10 code. Tina will change this.

2. After discussion, we decided that we will have the Boarding Location entries (with their Transfer Ready entries) be SEPARATE from the Service entries.

3. Regarding identification of boarding locations -- we debated recording the specific locations (from COGNOS) vs. mainly generic boarding locations.

  • We don’t actually need the specific locations, but it is less work for the data collectors to simply copy the location from COGNOS. However, this will create some issues regarding identifying boarding on different TYPES of wards (e.g. COVID wards) as a given ward can change function over time -- and this happens rapidly during the pandemic.
  • After discussion we agreed to go with recording the specific locations from COGNOS (assuming it’s correct). Tina to implement this change (as dropdown lists) at all 3 sites.
  • As the main issue here is COVID wards, Allan discussed with Nick and Ebi and they DO NOT still need to know about the patients boarding on such wards.

4. Discussion about Arrive DtTm and Accept DtTm

  • These are older concepts that have been superseded, and from now onwards we will recognize the equivalency of the following:
  • Furthermore, we recognized the importance of the following things:
    • A new record (ICU or Medicine) begins at the first Service tmp entry date and time when our service (respectively ICU or Medicine) takes over care. What we seek here is the TRUTH, which is not necessarily what is listed in COGNOS. In this regard, we agreed that if the true date/time of a service or location change is within 30 minutes of what is listed in COGNOS, we are OK with using the (slightly incorrect) COGNOS date/time. An issue that arises when collectors change such COGNOS listings is error messages for CSS, CUS and CE. Tina explained a procedure to avoid such error messages - the information is available in Using Cognos2 to keep track of patients (Tina confirmed).
    • The ICU team does not take over care DURING a code on the ward. When the ICU team runs a ward code, they are just performing a procedure (ACLS) for the ward team. We only will consider the ICU team as taking over care IF once the patient has survived the code, the ICU team has agreed to do so. So, this is not automatic. The primary way this will be noted is that the Medicine ward resident will write a note indicating this.
    • When a patient is intubated on the ward while still under the care of the ward team (e.g. during a code), we will NOT be coding the intubation procedure. We recognized that it is sufficiently implied by the combination of diagnosis code for Cardiac arrest along with the procedure code CPR, cardiac resuscitation.
  • Allan will work on the Definition of a Critical Care Laptop Admission Wiki page to make this all clear -- DONE.

5. Follow up regarding modifying the laptop input of Transfer Ready DtTm tmp entry for each boarding location:

  • Tina still to work with Julie and Sherry to make this data input less confusing.

6. Follow up regarding how to code a medicine patient boarding in Clinical_Assessment_UnitCAU -- Tina still to make the change indicating that we will not code CAU as a separate boarding location, but include it in with Ward boarding locations.

7. Followup on trying to get hospital-level data elements from EPR.

  • Allan provided Bojan/Ebi with a written explanation of what is being requested -- we need to followup on this item.

8. Followup about working to reduce collector workload. Things that need to be done:

  • After the COVID emergency passes, Allan to talk with Medicine leadership (including Ebi, Nick, Mary Anne, others) about precisely what information they need/want reported for Medicine ward patients within each hospital. The issue here is whether, within each hospital, they really need to distinguish data by ward, or by teaching vs. nonteaching.
  • Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
  • Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
  • Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].

ICU Database Task Group Meeting – March 24, 2021

  • Present: Allan, Tina, Julie, Trish, Brynn, Gladys, Pam, Mindy, Val
  • Minutes prepared by: AG
  • Action items in BOLD

1. Regarding the APACHE II comorbidities

  • We agreed to initiate the transition to having Julie identify these 5 comorbidities from ICD10 codes entered
  • Allan sent out a list of ICD10 codes to use for each of them, but Tina raised some questions about whether this list has been appropriately adjusted for the subset of ICD10 that WE use --- in response to this Allan revised the list of ICD10 codes and the while the following updated list does include some codes we don’t currently use, those elements are included in other listed codes:
    • Liver: B18.x, I85.x, I86.4, I98.2, I98.3, K70.x, K71.1, K71.3–K71.5, K71.7, K71.9, K72.1, K72.9, K73.x, K74.x, K76.0, K76.2–K76.9, Z94.4
    • Cardiovascular: I05.x-I09.x, I11.x, I13.x, I21.x, I22.x, I23.x, I24.8, I24.9, I25.x, I31.0, I31.1, I34.x-I39.x, I42.x, I43.x, I44.x-I49.x, I50.x, Z45.0x, Z94.1, Z95.0-Z95.4
    • Respiratory: I27.0, I27.2, I27.8x, I27.9, J40.x–J47.x, J60.x–J67.x, J68.x, J70.0, J70.4x, J84.x, J96.1x, J96.9x, Z99.1x
    • Renal: I12.x, I13.x, N03.x, N00.x-N08.x, N11.x, N12.x, N13.x, N14.x N16.x, N18.x, N19.x, N25.x, Z49.x, Z94.0, Z99.2
    • Immunocompromised: C81.x–C86.x, C88.x, C90.x–C97.x, C77.x–C79.x, B20.x–B22.x, B24.x, U92.25, Z51.0, Z51.1, Z92.25, Z92.3, Z92.6, Z92.8, T86.x, Z94.0, Z94.1, Z94.2, Z94.3, Z94.4, Z94.6, Z94.8x, D80.x-D84
  • Regarding the drug-induced immunosuppression portion of the immunocompromise comorbidity:
    • The data collectors agreed that this is doable. The source for this list is Template:List of immunosuppressive drugs
    • We will incorporate this into a custom/new ICD10 code we will call Drug-induced immunosuppression and give it code U92.25 -- this will be coded if the criteria for ANY of the list of immunosuppressive drugs is met. (added Ttenbergen 16:21, 2021 April 1 (CDT))
    • The question arose of whether Tocilizumab is on this list -- answer is Yes, it already is included.

2. Update on dealing with the COGNOS-derived, list of HSC Critical care services, specifically the fact that we decided on March 10 that for the 6 such services that don’t easily map to MICU vs. SICU, the collectors will have to manually identify the correct service. Tina added "HSC Critical Care - MICU" and "HSC Critical Care - SICU" to Service tmp entry options and emailed Julie and Lisa to update instructions how to use this.

3. Regarding attribution of infection. This appears to exist in 2 separate pages (Attribution of infections and Template:ICD10 Guideline Como vs Admit. Allan has now updated/clarified this issue on these two pages.

4. Regarding modifying the laptop input of Transfer ready date/time for each boarding location:

5. New items:

  • Regarding patients whose identity is unknown, including those who are using Stolen identities. Brynn to update the appropriate Wiki pages (Stolen identities, John or Jane Doe patient.
  • Regarding how to code a medicine patient boarding in CAU -- since CAUs at all sites are now being run by Family Medicine with ward nursing, this only comes up for us when such a bed is being used as a boarding location. We agreed (again, actually) that we will not code CAU as a separate boarding location, but include it in with Ward boarding locations. Tina to make this change.
  • This is Trish’s last meeting of the Task group as she retires at the end of this month. We all recognize her enormous contribution to the database and wish her best of luck.

5. Followup on trying to get hospital-level data elements from EPR.

  • Allan provided Bojan/Ebi with a written explanation of what is being requested -- we need to followup on this item.

6. Followup about working to reduce collector workload. Things that need to be done:

  • After the COVID emergency passes, Allan to talk with Medicine leadership (including Ebi, Nick, Mary Anne, others) about precisely what information they need/want reported for Medicine ward patients within each hospital. The issue here is whether, within each hospital, they really need to distinguish data by ward, or by teaching vs. nonteaching.
  • Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
  • Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
  • Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].

7. Next task meeting March 15 at 11 am.

SPECIAL ICU Database AJTT Task Group Meeting – March 11, 2021

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

1. Regarding Bed holds

  • These relate to patients who are sent away from the current hospital (A), to a different hospital (B) almost always for specific procedures, with the expectation they will return after the procedure. While this is usually the case, sometimes the patient remains after the procedure for an extended period, and (rarely) gets admitted to hospital B due to complications; but if that admission is to a location where we do not collect data, we have no way of knowing.
  • The question arose due to inconsistency about the existing guideline, and to knowing if/when the open record from hospital A should be ended. But in discussion we recognized that with the availability of hospital ADT (admission/discharge/transfer) information from COGNOS and the EMR, we probably do not need this concept at all.
  • We agreed on these rules (which Allan added to the Wiki):
    • If the patient did, at some point, return to hospital A from hospital B, and ADT indicates that the patient was NOT discharged from hospital A during the say in hospital B -- then the entire stay is in hospital A, including all the procedures done during the time at hospital B.
    • If the patient did, at some point, return to hospital A from hospital B, and ADT indicates that the patient WAS discharged from hospital A during the time at hospital B -- then we will consider this as TWO records in hospital A, with the first one ending when the patient physically left to go to hospital B (i.e. not when ADT shows the patient was discharged from A), and the second one starting when the patient returned to hospital A. In this case, the procedures that occurred during the time in hospital B are not included in either record for hospital A unless they include an Admit Procedure for the 2nd admission to hospital A.
    • If the patient did NOT return to hospital A from hospital B then there will be an indication in ADT of the discharge from hospital A, and our single hospital A record is taken to end on the date of ADT discharge.
      • NOTE for Julie -- if such a patient was admitted in hospital B to a location where we collect, then the hospital A and B records will be flagged in the data check as having overlapping times. In that case the end of the hospital A record should be taken as the time of the hospital B admission.
  • We recognized that these new rules mandate alterations to Wiki entries LOS Medicine per hospital admission and Continuous Stay, and likely creation of equivalent entries for ICU. Allan and Julie will work on these.

2. Regarding Group homes

  • The issue here is that in truth there are numerous different types of group homes, with different amounts and types of support (Care levels in the community) provided in them. BUT, the data collectors can’t easily find out these details and this leads to uncertainty about what “level” of care to code group homes. After discussion we agreed that we will put all types of Group Homes as “Supportive Housing”. Tina has fixed this on the wiki.

3. Regarding Chronic Health APACHE

  • Allan has revised the ICD10 codes that we will use to automate identification of the 5 APACHE II comorbid conditions, i.e.:
    • Liver: B18.x, I85.x, I86.4, I98.2, K70.x, K71.1, K71.3–K71.5, K71.7, K72.1, K72.9, K73.x, K74.x, K76.0, K76.2–K76.9, Z94.4
    • Cardiovascular: I50.x, I21.x, I22.x, I23.x, I24.8, I24.9, I25.x, Z94.1, I05.x-I08.x, I11.x, I13.x, I42.x, I43.x, I09.2, I09.9, I31.0, I31.1, I31.9, A52.0, I05.x-I08.x, I09.1, I09.8, I34.x-I39.x, Z95.0-Z95.4, I44.x-I49.x; R00.0, R00.1, R00.8, Z45.0x
    • Respiratory: I27.0, I27.2, I27.8, I27.9, J40.x–J47.x, J60.x–J67.x, J68.4x, J70.1x, J70.3x, J70.4x, J84.x, J96.1x, J96.9x, Z99.1x
    • Renal: I12.x, I13.x, N03.x, N05.2-N02.9, N07.2-N07.9, N08.3x, N08.4-N08.8, N11.x, N12.x, N18.x, N19.x, N25.0, Z49.x, Z94.0, Z99.2
    • Immunocompromised: C81.x–C86.x, C88.x, C90.0, C90.1, C90.x–C97.x, C77.x–C79.x, B20.x–B22.x, B24.x, Z51.0, Z51.1, Z92.3, Z92.6, J70.0x, K52.0, K62.7, L58.0, T86.x, Z94.0, Z94.1, Z94.2, Z94.3, Z94.4, Z94.6, Z94.8, D80.x-D84.xD80.x-D84.x
  • The one remaining issue is immunocompromise due to medications. This Template:List of immunosuppressive drugs (which Allan updated) is long and at our next task meeting we will discuss with collectors whether or not it is feasible to have them review for every patient whether they were on any of them PRIOR to admission.

4. Regarding the “public face” of the databases, i.e. the CCMDB splashpage (https://ccmdb.kuality.ca)

  • Substantial work needs to be done on the links from this page -- many are out of date.
  • This relates to the items on Public Entrance Likely Initial Page
  • It was agreed that in order to start making progress on this myraid of Wiki page modifications, Julie, Tina, and whoever replaces Trish will set aside 3-4pm every Thursday to work on these collaboratively.

ICU Database Task Group Meeting – March 10, 2021

  • Present: Allan, Tina, Julie, Trish, Brynn, Gladys, Sherry, Pam, Micheel, Stephanie, Mindy, Iris, Mailah, Barret, Val
  • Minutes prepared by: AG
  • Action items in BOLD

1. Continued discussion of following location and service of patients admitted to an ICU service

  • Also see the February 10, 2021 minutes
  • Since the last meeting, we have discovered that the long list of “Critical care” services do NOT come directly from hospital admitting offices, which (e.g. at HSC) only code “Medicine”, “Critical care”, and “Intermediate”. The long list is generated subsequently and we do not know exactly how this is done (or why).
  • After considerable discussion we agreed that going forwards we will:
    • Use the COGNOS-derived, long list of Critical care services. The majority of these map easily to the correct ICU service (e.g. MICU vs. SICU, ICMS vs. ICCS). However for those that do not map well to a single ICU service, the collectors will have to manually identify the correct service. Tina to create machinery to do this.
      • The list of these services that do not map well are:
        • HSC Critical Care / Adult General
        • HSC Critical Care / Amputee
        • HSC Critical Care / General
        • HSC Critical Care / Intensive Care
        • HSC Critical Care / Obstetrics
        • HSC Critical Care / Oncology
    • We will cease sending corrections back to the admitting offices.

2. No update today on locations listed in Cognos that are variously called Swap or Swing at the different hospitals. These may or may not actually related to a change in physical locations. We need to sort out how we are going to handle these. Tina will review and we’ll discuss further.

3. Regarding attribution of infection. This appears to exist in 2 separate pages (Attribution of infections and Template:ICD10 Guideline Como vs Admit. Allan to consolidate and simplify these.

4. Continued discussion about Transfer ready date/time -- with the recent change to allow such an entry for each “boarding location”

  • We re-clarified that there should only be such a date/time when the intent is for a patient at a given level to go to a LOWER level of care.
  • We re-clarified that for each boarding location entry, collectors should not look back at the entry for prior locations -- i.e. for a given location only put in an entry if the care team wrote such an intention to transfer to a lower level of care during the time the patient was actually on that location.
  • Julie reported that she is seeing such a date/time entered related to every location transfer, even to the SAME level.
  • It was agreed that part of these problems is the way that the temp table appears on the laptops -- Tina will work to make it less confusing.
  • New question raised of what to do when the patient’s care is taken over in ED (either Medicine or ICU) and then the patient goes to Medicine or ICU. The clarification here is that for such location changes, this is considered the SAME level of care.
  • Allan updated the wiki page about all of this.

5. Followup on trying to get hospital-level data elements from EPR.

  • Allan provided Bojan/Ebi with a written explanation of what is being requested -- we need to followup on this item.

6. Followup about working to reduce collector workload. Things that need to be done:

  • After the COVID emergency passes, Allan to talk with Medicine leadership (including Ebi, Nick, Mary Anne, others) about precisely what information they need/want reported for Medicine ward patients within each hospital. The issue here is whether, within each hospital, they really need to distinguish data by ward, or by teaching vs. nonteaching.
  • Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
  • Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
  • Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].

SPECIAL ICU Database AJTT Task Group Meeting – February 22, 2021

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

1. Discussion regarding HSC critical care service categorization:

  • Allan related that he had emailed with Rachel Porter and espoused to her that this problem could largely be addressed by reconsidering the plethora of potentially unnecessary service categories for critical care, at all sites. He hasn’t heard back from her but will recontact her -- DONE 2/25/2021.
  • But in the interim we need to map the remaining HSC ICU codes to the specific ICUs and have done so as follows:
    • HSC Critical Care / Adult General -- SICU
    • HSC Critical Care / Amputee -- SICU
    • HSC Critical Care / General -- SICU
    • HSC Critical Care / Intensive Care -- MICU
    • HSC Critical Care / Obstetrics -- MICU
    • HSC Critical Care / Oncology -- SICU

2. Update about Green Sheets --- Allan related that the only ICU where at least some of the attendings value them is at HSC. Furthermore, the Bojan and the other ICU directors decided that they will take over all aspects of green sheets.

3. Regarding observation for COVID.

SPECIAL ICU Database AJTT Group Meeting – February 11, 2021

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

1. Julie proposed converting the current temp file collection of: (a) boarding location, (b) transfer ready date/time, and (c) service into permanent database columns. And at the same time terminating the collection of Arrival date/time.

  • There was agreement that this makes good sense. However, Tina demonstrated how this will mandate altering many dozens of Wiki pages which will require perhaps 2 weeks of work by the 4 of us.
  • Given the added workload related to COVID, along with the seconding/absence of most of our data collectors, it was decided that we will revisit doing this in October 2021, with the hope that the COVID-related problems will have resolved, but that we’ll set about this task even if that is not true.

2. It was pointed out by Julie that some data requests and even quarterly reports from early 2020 and early 2021 are seriously compromised by the lack of collectors. This includes TISS data elements.*Julie related that she has been trying to use workarounds to nonetheless obtain some of this data, but there was recognition that while this may be the best we can do for now, that it leads to eventual rework and inefficiencies elsewhere in the system. Consequently, Allan opined that we should cease such workarounds and that he would communicate with Bojan about this. The upshot of that communication is that the ICU program understands and prefers to wait until good quality data is available, rather than reporting data that is substantially incomplete and/or questionable. This likewise applies to attempts to fill in portions of TISS data for reporting to the OIT Committee --- Allan likewise communicated this to Kendiss/Carmen who co-lead the OIT Steering Committee.

  • Thus, it was decided that we will do what we can moving forward, but that with the current COVID-related limitations, we will cease trying to “fill in” gaps in prior data (e.g. 4th quarter 2020), and that it is acceptable to delay reporting problematic items in quarterly reports.

ICU Database Task Group Meeting – February 10, 2021

  • Present: Allan, Tina, Julie, Trish, Barret, Sherry, Val, Joyce, Gail, Stephanie, Gladys, Pam
  • Minutes prepared by: AG
  • Action items in BOLD

1. Continued discussion of following location and service of patients admitted to an ICU service

  • There was recognition that Cognos data is not sufficiently accurate to rely entirely on it, i.e. collectors must verify changes in location, changes in service, and the timing of changes. Thus, they will, for the forseeable future, need to use both, as Cognos is of value as a starting point. Sherry and Tina to clarify this on the Wiki.
  • Regarding the button Tina created on the laptops that collectors can use to send a templated email to admitting offices when they identify an error regarding an ICU admission by either service or location. Allan to call admitting offices at Grace and HSC to identify the person at each site to whom this email would be sent.

2. Update regarding having data collectors do all TISS coding at all sites. Trish reports that not all collectors have yet learned how to use the laptop tool to do this.

3. No update today on locations listed in Cognos that are variously called Swap or Swing at the different hospitals. These may or may not actually related to a change in physical locations. We need to sort out how we are going to handle these. Tina will review and we’ll discuss further.

4. Allan to recheck the ICD-10 coding for the APACHE comorbid conditions.

5. Regarding attribution of infection. This appears to exist in 2 separate pages (Attribution of infections and Template:ICD10 Guideline Como vs Admit. Allan to consolidate and simplify these.

6. Revisiting topic of the new temp entries of boarding location and service.

  • There are common errors (e.g. duplicate data, conflicting data). Cross-checks are being created and with those many/most of these problems should go away. But some aren’t easily amenable to cross-checks, and this has to do with cross-checking against records which are not yet complete.
  • After discussion we leaned towards only doing cross-checks against complete data -- but Julie pointed out that she needs information prior to completion of records of whether TISS is completed or not. Allan, Tina, Trish and Julie will have a separate meeting to discuss this -- DONE, see minutes from special AJTT meeting February 11, 2021, above.

7. Allan, Julie and Tina reported that they had an offline discussion about the best way to deal with Transfer Ready date/time (meaning to a location of a LOWER level) in the “patient follow” method of assigning patients to collectors.

  • It was finally decided that there should be a mandatory entry of this item for each boarding location, and if there was no transfer ready date for a location then a box will be checked denoting that there was no such date/time. And in particular, with respect to collection of this information, we do NOT want collectors to refer back to such date/time in any prior locations, i.e. only use information written by the primary team at the current location.
  • Sherry and Tina will communicate on making the laptop tool for doing this easier to use.
  • Allan reported that Bojan said that "unnecessary days" calculation should NOT include such days if spent in ED.
  • Sherry pointed out that this new mandate seems to duplicate the similar Z75 “family” of ICD10 codes (e.g. Awaiting/delayed transfer to long-term care/PCH inside or outside of Winnipeg). At our next task meeting we will discuss this further.

8. New item: Gail inquired about coding VAP in somebody already having severe COVID pneumonia. Discussion highlighted that it is very difficult to discern a new VAP on top of an existing COVID lung process, but that nonetheless we should simply follow the VAP guideline on this.

9. Followup on trying to get hospital-level data elements from EPR.

  • Allan provided Bojan/Ebi with a written explanation of what is being requested -- we need to followup on this item.

10. Followup about working to reduce collector workload. Things that need to be done:

  • After the COVID emergency passes, Allan to talk with Medicine leadership (including Ebi, Nick, Mary Anne, others) about precisely what information they need/want reported for Medicine ward patients within each hospital. The issue here is whether, within each hospital, they really need to distinguish data by ward, or by teaching vs. nonteaching.
  • Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
  • Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
  • Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].

ICU Database Task Group Meeting – January 20, 2021

  • Present: Allan, Tina, Julie, Trish, Barret, Lisa, Stephanie, Pam, Joyce, Gladys, Mailah, Iris, Gail, Sherry, Val
  • Minutes prepared by: AG
  • Action items in BOLD

1. Continued discussion of following location and service of patients admitted to an ICU service.

  • Tina reported that she has not yet created a button (Eyes button) on the laptops that will allow collectors to send a templated email to St. B admitting when they identify an error regarding an ICU admission by either service or location. Furthermore, she’ll ensure that we can count the number of these. We’ll do this for at most a few months, with the hope that this feedback will allow St. B admitting to improve their processes and reduce these errors.
  • Allan to call admitting offices at Grace and HSC to identify the person at each site to whom this email would be sent.
  • It was also recognized that for ICU it is not too difficult for collectors to manually identify and input the location and service --- Tina and Trish will discuss the option of just doing it manually.

2. Update regarding having data collectors do all TISS coding at all sites. This is to take effect starting December 7, 2020 but not much progress since last meeting given all the COVID issues with collectors and collecting.

3. No update today on locations listed in Cognos that are variously called Swap or Swing at the different hospitals. These may or may not actually related to a change in physical locations. We need to sort out how we are going to handle these. Tina will review and we’ll discuss further.

4. Allan to recheck the ICD-10 coding for the APACHE comorbid conditions.

5. Regarding attribution of infection. This appears to exist in 2 separate pages (Attribution of infections and Template:ICD10 Guideline Como vs Admit. We need to consolidate and simplify these.

5. New topic of the workload involved with the new temp entries of boarding location and service.

  • This involves Julie and Pagasa checking that the data makes sense. But there are common errors (e.g. duplicate data, conflicting data). Cross-checks are being created and with those many/most of these problems should go away. But some aren’t easily amenable to cross-checks, and this has to do with cross-checking against records which are not yet complete.
  • After discussion we leaned towards only doing cross-checks against complete data -- but Julie pointed out that she needs information prior to completion of records of whether TISS is completed or not. Allan, Tina, Trish and Julie will have a separate meeting to discuss this.

6. Offline, Allan, Julie and Tina discussed the best way to deal with Transfer Ready DtTm tmp entry (meaning to a location of a LOWER level) in the new “patient follow” method of assigning patients to collectors. It was finally decided that:

  • There will be a mandatory entry of Transfer Ready DtTm tmp entry for each Boarding Loc, though if there was no transfer ready date for a location then a box will be checked denoting that
  • In assessing the # of “unnecessary days” this will be done at a given LEVEL (e.g. ICU>IICU>High Obs>Ward>home, PCH, rehab)
  • An approach was worked out in this conversation that included: (i) using the earliest such date/time within a given level, but (ii) resetting the date/time when the a patient moves to a higher or lower level.
  • Also, Allan will contact Bojan and Nick to ask whether in the reporting of "unnecessary days" they want to include or exclude such days if spent in ED.

7. Followup on trying to get hospital-level data elements from EPR.

  • Allan provided Bojan/Ebi with a written explanation of what is being requested -- we need to followup on this item.

8. Followup about working to reduce collector workload. Things that need to be done:

  • After the COVID emergency passes, Allan to talk with Medicine leadership (including Ebi, Nick, Mary Anne, others) about precisely what information they need/want reported for Medicine ward patients within each hospital. The issue here is whether, within each hospital, they really need to distinguish data by ward, or by teaching vs. nonteaching.
  • Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
  • Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
  • Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].

ICU Database Task Group Meeting – January 7, 2021

  • Present: Allan, Tina, Julie, Trish, Pam, Lisa, Sherry, Val
  • Minutes prepared by: AG
  • Action items in BOLD

1. Continued discussion of patients admitted to an ICU service.

  • Collectors relate that the COGNOS listings are pretty accurate at HSC and Grace, and improving at St. B.
  • Tina spoke to Chantal Plaetinck (manager of Admitting at St. B) about the ongoing issues there. After discussion we agreed that Tina will create a button on the laptops that will allow collectors to send a templated email to St. B admitting when they identify an error regarding an ICU admission by either service or location. Furthermore, she’ll ensure that we can count the number of these. We’ll do this for at most a few months, with the hope that this feedback will allow St. B admitting to improve their processes and reduce these errors. (see Process for bad data in Cognos)
  • In order to finish mapping COGNOS HSC Critical Care services to either MICU or SICU, Julie updated the following for up to 1/4/2021, so it now includes 4 months of data:
    • HSC Critical Care / Adult General -- 1 of these, in SICU
    • HSC Critical Care / Amputee -- 0 of these
    • HSC Critical Care / General -- 4 of these, in SICU
    • HSC Critical Care / Intensive Care -- 4 of these, 2 in MICU, 2 in SICU
    • HSC Critical Care / Obstetrics -- 2 of these, 1 in MICU, 1 in SICU
    • HSC Critical Care / Oncology -- 3 of these, in SICU
  • In response to discussion, Allan indicated that while we DO want to get locations, services and timing all correct, that it is not the end of the world if we are off by 1-2 hours in the actual timing of when a change occurred.

2. Update regarding having data collectors do all TISS coding -- Tina, Trish and the collectors are still working to get this going at all sites.

3. Update on the discrepancy between collection of PRBC transfusions in CCI vs. the Transfusion guideline. After discussion we agreed (largely for simplicity of coding) that the rule will be: Code the 1st date of PRBC administration and the total number of units of PRBC given from that point onward. Tina fixed this discrepancy and Val will look at the Wiki information about it to ensure it is correct.

4. Update on “locations” listed in Cognos that are variously called “Swap” or “Swing” at the different hospitals. These may or may not actually related to a change in physical locations. Clearly we need to sort out how we are going to handle these. Tina will review and we’ll discuss further at the next Task meeting.

5. New questions

  • (a) It was identified that there can be discrepancies between the time a transfer (of location or of service) is noted in COGNOS vs. when it truly occurs.
    • Example: ICU transfer to ward is listed earlier (and sometimes substantially earlier) in COGNOS then when it actually occurs. In this case the COGNOS time should be the “transfer-ready” time, while the actual time should be the service/location change time.
    • As per item#1, above, while we DO want to get timing correct, it is not a huge problem if a service or location time change is recorded an hour off from reality.
  • (b) It was pointed out that WHO has begun creating temporary, codes for newly-described COVID complications. An example is COVID-19–related multisystem inflammatory syndrome (U07.3).
    • This is a syndrome, so far only described in children, with numerous manifestations depending on which organ or organs are involved.
    • As we have only had ONE of these so far, we agreed that we will not give it its own ICD10 code, but instead code it by linking COVID-19–related multisystem inflammatory syndrome to the existing code Disorder of the immune system, NOS. Allan has added this to the COVID-19 Wiki article.

Tina has added Post COVID-19 condition as per discussion with Allan 2021-01-12.

6. Followup on trying to get hospital-level data elements from EPR.

  • Allan provided Bojan/Ebi with a written explanation of what is being requested -- we need to followup on this item.

7. Followup about working to reduce collector workload. Things that need to be done:

  • After the COVID emergency passes, Allan to talk with Medicine leadership (including Ebi, Nick, Mary Anne, others) about precisely what information they need/want reported for Medicine ward patients within each hospital. The issue here is whether, within each hospital, they really need to distinguish data by ward, or by teaching vs. non-teaching.
  • Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
  • Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
  • Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].

ICU Database Task Group Meeting – December 16, 2020

Last from 2020, copied here as a starting point for the first meeting in 2021, these should be overwritten

1. Continued discussion of PatientFollow Project, Change from Service Location to Service, Boarding Loc and Transfer Ready DtTm tmp entry, Definition of a Medicine Laptop Admission

  • Further questions arose of which Onc, Renal, Neuro patients to include in the Medicine database. After discussion we recognized that the issue here is whether or not the patient is “using Medicine resources”, which include staff and beds. So, by this criterion:
    • We WILL include Onc, Renal, Neuro patients who are physically located on a mixed COVID ward (i.e. locations that have both Medicine and non-Medicine (e.g. surgery) beds). Rationale is that those beds ARE a Medicine resource.
    • We will NOT include Onc, Renal, Neuro patients who are in ED (e.g. EMIPs). Rationale is that those beds are NOT a Medicine resource.

2, Continued discussion of patients admitted to an ICU service.

  • Last meeting we mapped existing Cognos services to their respective ICUs in each site. This was possible with all except the following 7 services, for which Julie has now gone back and over the past 2 months identified patients with those services:
    • HSC Critical Care / Adult General -- 0 of these
    • HSC Critical Care / Amputee -- 0 of these
    • HSC Critical Care / General -- 2 of these, both in SICU
    • HSC Critical Care / Intensive Care -- 3 of these, 2 in MICU, 1 in SICU
      • HSC Critical Care / Obstetrics -- 1 of these, in MICU
    • HSC Critical Care / Oncology -- 1 of these, in SICU
  • So, there seem to few enough of these that categorization isn’t a big problem. HOWEVER, Tina identified that working with Chastity she has now come to recognized that Cognos has 3 concepts within it that relate to service. SO before we go further with assigning patients to ICU services, Tina/Julie will look further into this and we’ll discuss further at our next Task meeting.

3. Followup on the recent changes St. B admitting made as regards to identifying ICU services.

  • Collectors report that things have greatly improved, though some mistakes are still being made. In particular, there is use made of the service “SBGH Critical Care / General”. We hope that these errors will decline as Admitting office staff become more familiar.
  • But we also decided to defer further discussion of this to the next Task meeting, for same reason as the last point of item#2, above.

4. Followup regarding having data collectors do all TISS coding

  • Has only begun at St. B, not yet at HSC or Grace where pink sheets are still being used
  • Towards the goal of making this change in all sites, Tina and Trish will work with collectors to fine-tune the laptop tool for collecting TISS info, and to get them trained up to use it.

5. New questions

  • Whether and how to code someone who has recovered from COVID-19. After discussion we agreed this is no different from any infection, and that once active infection is gone (even if manifestations such as respiratory fibrosis and respiratory failure remain) that we will NOT code it. Specifically, as the WHO has not seen fit to create an ICD-10 code for past history of COVID-19, we won’t either.
  • It was pointed out that there is a discrepency between collection of PRBC transfusions in CCI vs. the Transfusion guideline. After discussion we agreed (largely for simplicity of coding) that the rule will be: Code the 1st date of PRBC administration and the total number of units of PRBC given from that point onwards. Tina to fix this discrepency.
  • There are “locations” listed in Cognos that are variously called “Swap” or “Swing” at the different hospitals. These may or may not actually related to a change in physical locations. Clearly we need to sort out how we are going to handle these. Tina will review and we’ll discuss further at the next Task meeting.
  • Discussion about what name to use for what has previously been called “Boarding Loc”. In Cognos it goes by the name “assigned unit”, but this may ambiguously imply the final destination. So we agreed to call this field “Unit”.

6. Followup on trying to get hospital-level data elements from EPR.

  • Allan provided Bojan/Ebi with a written explanation of what is being requested -- we need to followup on this item.

7. Followup about working to reduce collector workload. Things that need to be done:

  • Find a new hosting/software infrastructure that can be in full compliance with privacy requirements. Allan and Tina will followup with CHI and Digital Health to pursue new hosting possibilities.
  • Thereafter, work to obtain CBS TraceLine for all transfusion data. Margaret Ring again (margaret.ring@blood.ca).
  • Thereafter, work to obtain RIS data for radiology tests. Shared Health CIO Charles Conway [204-926-1400; cconway3@sharedhealthmb.ca].

ICU Database Task Group Meeting – December 11, 2019

See Task Team Meeting - Rolling Agenda and Minutes 2020#ICU Database Task Group Meeting – December 16, 2020