Task Team Meeting - Rolling Agenda and Minutes 2022

From CCMDB Wiki

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
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 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)
  • Just wondering where this is at, is there a new target date? (Pam)
    • Good question; Julie and I keep finding more things that use the old dates, and we are working on shifting them to the new dates. Not sure about a target date. Ttenbergen 13:23, 2022 January 17 (CST)
17 January 2022 19:23:41
Cognos2 Hospital Discharge query
  • This query raises the possibility of also capturing Hospital disposition and dttm, a value Allan has wanted for a long time. But it also raises the problem that we are only finalizing records late now, and do we want to risk similar delay going fwd?

We might be able to convince the Cognos people to stretch the query to include this, but that's somewhat unlikely. However, the number of records for which this would not come in time for us to collect it might be small enough for Pagasa to grab after the fact? How small would it need to be for that to be feasible?
That would raise the question of who and how...

    • At sites where they are up to date or have a dedicated collector for that laptop only would likely not use this, as EPR lists can be used
  • This is a work in progress. Feel free to have a look at the query and test it. Let me know if things are missing or if you have suggestions. Ttenbergen 10:40, 2021 September 29 (CDT)
    • Hey Tina, the query is super helpful for us, just a couple of comments, it would be helpful if we could somehow get to the profile from this page so we could just enter it, you know the binoculars thing, also if it would somehow drop off once we do enter it? This may be big asks or not even feasible to program, but thought I would ask, thank you for creating the query!! Lisa Kaita 10:06, 2021 October 15 (CDT)
      • Yes, I can add a button once I turn it into a form. There might be more than one profile for the patient on the laptop. Both will be listed, so the collector will need to keep an eye on that. But I wonder: is the next step actually to open the profile, or is it to request the chart? What would a collector do in there at that point? Because maybe what we need instead is something optimized to request the next round of charts? Then the collector would open from PatientList as they go through charts. Just trying to make sure we tie this into the actual process rather than add functionality just because we can. Ttenbergen 15:51, 2021 October 19 (CDT)
        • We go into the profile to change the record to MR*, to replace where the patient was e.g. A3S (A3stepdown lets us know as a quick glance that the patient is still in hospital, once discharged we change it to MR*) it puts it to the bottom of our MR list. When we are ready to request the chart we remove the *, generate the MR list, and then request it from medical records.
          • That is interesting. Is the MR* technique actually across sites? This is not documented anywhere, eg. Record field and MR List. If this is common procedure, then would it be better functionality to just change all records that now have a hosp discharge to have record = MR*? It doesn't sound like something that benefits from human intervention... Ttenbergen 09:50, 2021 October 20 (CDT)
20 October 2021 14:50:44
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
Labs data
  • Can we try to have blood gas results uploaded to EPR at the GGH? currently the blood gas results are transcribed from the lab report to a flowsheet. Often there are missing gases on either the flow sheet or hard copies of the lab report, this is time consuming for the collector to reconcile. Blood gases are uploaded to EPR for GGH ER and there was some talk about doing this some time ago. The manager for GGH repiratory is Ingrid Murphy Lisa Kaita 12:25, 2021 October 26 (CDT)
26 October 2021 17:25:14
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)
25 November 2021 17:25:04
Swap Locations
  • 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)

  • 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.
    • if the collector believes there is a discrepancy in Cognos with the bed locations/swing bed entries, it is verified by reviewing EPR and documentation if pt has actually arrived to the unit. Because there are so many different units being used now, reviewing EPR is done more frequently. If this review reveals the discrepancy then "excluding" the line(s) will usually work
21 January 2022 18:53:12
Visits to temporary locationsI have a patient who went from the ward to the endo suite, code blue in endo and then direct to OR, according to these instructions my dispo dt/tm is to the endo suite, but we do not have an option for this in our dispo dropdown, should I use HSC_OR or should we create an option for endo suite? If I use OR then I include everything that happened in the endo suite? Lisa Kaita 10:07, 2022 January 19 (CST)19 January 2022 16:07:27

Also see Task Team Meeting - Rolling Agenda and Minutes 2020



ICU Database Task Group Meeting – January 6, 2022

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

1. Update on new lab listings, which appear to duplicate prior listings. Allan has begun working on this. Nothing new to report.

2. Update on what Shared Health is planning with regards to the databases. Allan reported that as requested, he provided Perry with a document (from Tina) a technical description of what is needed. Awaiting more information from Perry.

3. Update on plan (4/15/2021 Task meeting) to implement automatic coding of APACHE comorbidities. Allan is working on refining the ICD10 codes.

4. Update on the decision from 11/30/2021 meeting to revert to the old system, of starting a new record (with new APACHE score and new admit diagnoses) with service changes. This has been done, with relevant changes to the Wiki and “unwinding” of the 10 records that contain such MICU to SICU or SICU to MICU transfers into separate records.

5. Allan reported that he is working on drafting a Data Sharing Agreement that all users of line-level (i.e. individual record) data will need to complete to obtain such data. Draft version is in Database_Request_Process#Data_Accessibility_and_Responsibility. Work is ongoing on this. Also, a decision will need to be made about whether we need a similar agreement for users of cumulative/aggregate data.

6. Discussion about the Minimal Data Set and reporting. We agreed:

  • We will retain the 11 elements of the “true” minimal dataset, all of which come from Cognos.
  • Going forwards, all reporting by Julie will consist of details only from completed records, along with information about what % and # of records for the time interval are incomplete as of the time of the reporting.
  • Lisa will let all collectors know of this change
  • Tina has updated Minimal Data Set regarding it
  • Allan will let Bojan know -- done.

7. There is a new ICD10 code U07.5 Past history of Covid-19 infection which is meant to be used just like the other “Past history of…” codes. Lisa to let all collectors know about it.

8. After discussion we agreed that there is no further need for the Wiki page "HSC Boarding Locations". Tina has deleted it.

9. The question was raised about definition of Emergency Surgery (concept). After discussion we agreed to maintain it as is, i.e. admitted from Operating Room or Recovery AND surgery was classified as E1. Tina has updated wiki Emergency Surgery (concept), Emergency Surgery (TISS Item) and Admit Type for APACHE II to make sure this is defined consistently.

10. There is confusion about TISS elements T19 - Spontaneous breathing via ETT without PEEP/CPAP, with or without supplemental O2 (TISS Item) and T20 - Supp O2 though any device, delivered via nose, mouth, ETT or trach (TISS Item) .

  • This issue tracks back to the 6/15/2021 and 7/8/2021 minutes where indeed the current versions of TISS#19 and TISS#20 were chosen, both as 2 points, in order to correlate correctly to the original/actual delineation of TISS. So, no changes needed for these.

11. Tina identified that there are approximately 200 database questions that have been assigned for assessment but not addressed. Lisa will go over this list and categorize them into 3 groups: Need to be addressed; Can be deleted from further consideration; Unclear. We’ll discuss this further next meeting.

12. Next meeting February 3, 2022 at 11 am.


Also see Task Team Meeting - Rolling Agenda and Minutes 2021