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

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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 – 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


== SPECIAL ICU Database AJTT Task Group Meeting – February 22, 2021 ==  
== SPECIAL ICU Database AJTT Task Group Meeting – February 22, 2021 ==  
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3.  Regarding observation for COVID.   
3.  Regarding observation for COVID.   
*It was noted that some collectors are including this combination of ICD10 codes ([[Observation for suspected infection NOS]] + [[COVID-19 (SARS-COV-2)]]) for every swab sent to the lab.  It’s clear this is not what we want and Allan has modified the COVID wiki page accordingly.
*It was noted that some collectors are including this combination of ICD10 codes ([[Observation for suspected infection NOS]] + [[COVID-19 (SARS-COV-2)]]) for every swab sent to the lab.  It’s clear this is not what we want and Allan has modified the COVID wiki page accordingly.


== SPECIAL ICU Database AJTT Group Meeting – February 11, 2021 ==  
== SPECIAL ICU Database AJTT Group Meeting – February 11, 2021 ==  

Revision as of 11:58, 2021 March 11

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.
Iatrogenic, mechanical complication/dysfunction, internal prosthetic device or implant or graft NOSAt our last TASK meeting the decision was made to exclude spontaneous rupture of an ETT cuff or cuff leak, but we are wondering if this is correct based on what is listed in the includes section of this page and what is in Iatrogenic, mechanical complication/dysfunction, internal orthopedic prosthetic device or implant or graft or bone device and Iatrogenic, mechanical complication/dysfunction, cardiac or vascular prosthetic device or implant or graft, NOS Lisa Kaita 12:37, 2024 March 20 (CDT)20 March 2024 17:37:32
STB ICUs VAP Rate, CLIBSI Rate Summary
  • IIRC we collected CAM positive (TISS Item) specifically for this, right? If so, can we stop collecting it? And can we make sure a stoppage like this in the future results in reviewing what we collect? Ttenbergen 10:02, 2024 March 20 (CDT)
    • Delirium rate per 1000 days per unit is being reported in the OIT reports. ---JMojica 11:49, 2024 March 20 (CDT)
      • As in Delirium days is reported in Critical Care Program Quality Indicator Report? But that doesn't mention anything about per-1000-days. Ttenbergen 17:00, 2024 March 20 (CDT)
      • The rate is mentioned in the succeeding definition with the delirium days as numerator. Your proposal here is to stop collecting TISS item CAM positive which I disagree because that TISS item is being used and reported as rate in OIT report. Besides, the reason why it was dropped in in the STB VAPCLI report is because the requestor has changed. Brett Hiebert who used to request this was involved in the VAP group and another Delirium group so he asked to have both as one request. Brett had left and the VAP group filled up a new request to continue the VAP data and not on the delirium data. --JMojica 13:58, 2024 March 25 (CDT)
25 March 2024 18:59:38

Also see Task Team Meeting - Rolling Agenda and Minutes 2020

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


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