Task Team Meeting - Rolling Agenda and Minutes 2022: Difference between revisions

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(Created page with "__NOTOC__ == List of items to bring to task meeting == Add to this by adding the following '''to the article where the problem is documented''': <pre>{{DiscussTask | explanation}}</pre> <!-- As generated by Semantic Mediawiki --> {{#ask: DiscussWho::Task | searchlabel=Task Questions | ?DiscussQuestion = Question | limit=100 | ?Modification date | format=table }} Also see Task Team Meeting - Rolling Agenda and Minutes 2020 ___TOC___ == ICU Database Task G...")
 
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== ICU Database Task Group Meeting – January 6, 2022 ==  
== ICU Database Task Group Meeting – January 6, 2022 ==  
... most recent minutes just for Allan's convenience, should be taken out after this meeting, I just put them here so we have something to edit.
*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'''.


''' ICU Database Task Group Meeting – November 30, 2021'''
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'''.


*Present: Allan, Julie, Sherry, Lisa, Stephanie, Tina, Val, Barret, Pagasa, Pam, Mailah
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.
*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'''.
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.


2. Update on what Shared Health is planning with regards to the databases.  Allan reported that a meeting will happen immediately after this one including Ebi, Bojan, Perry and himself. Update written after that meeting: It was decided to first address the migration of the databases to an e-Health server. To this end, Tina has supplied a technical description of what is needed, which '''Allan will give to Perry''', which he will use to start discussion with e-Health.
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.


3. Followup regarding if/how to ensure correctness of counts of intubations/extubations
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'''.
*Plan is to implement this as a “soft crosscheck” [[query check_CCI_TISS_discontinuous_ETT]]. '''Tina has emailed Julie and Lisa further questions Dec 2.'''


4. Update on plan (4/15/2021 Task meeting) to implement automatic coding of APACHE comorbidities (i.e. from the documented ICD10 diagnoses, per the schema Allan gave to Julie some time ago). See [[Change for Apache Chronic to ICD10 from separate variable]]
8. After discussion we agreed that there is no further need for the Wiki page "HSC Boarding Locations". '''Tina has deleted it'''.
*'''Tina started validation of the data and found various problems, see [[Change for Apache Chronic to ICD10 from separate variable]].'''


5. We continued discussing the issue of what should constitute a record in the ICU database.
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'''.
*We recognized that there are problems with both the old method (new record with each transfer of ICU service) and the new method (a single record representing an entire episode of ICU care, including ICU-to-ICU transfers).
*On the day following this meeting, Allan, Julie, Tina, Brynn and Lisa met to discuss further and finally '''decided to go back to the old system, which actually has only been implemented in regards to MICU to SICU or SICU to MICU transfers at HSC'''. To this end we will:
**Re-do APACHE scoring with each transfer of ICU service.
**Re-do admit diagnoses with each transfer of service.
**Ensure all the relevant Wiki pages represent this decision -- '''Tina and Brynn to work on this'''
**”Unwind” the 10 records that contain such MICU to SICU or SICU to MICU transfers into separate records -- '''Julie will work with Brynn and Lisa to do this'''.
**Maintain the current machinery, tied to the Boarding Loc temp entries to record TISS scores when a patient is in multiple locations on a single calendar day.
**Main the current machinery with respect to the Service temp entries -- the rational has to do with the fact that it is initially obtained from COGNOS, and then verified by collectors.
**'''Notify all collectors of this decision'''. '''Lisa email sent out Dec 7 to all collectors'''


6. Regarding prior discussion (see Nov 2 minutes) of: (a) whether or not to include incomplete charts in Julie’s reports (both quarterly reports, and the various monthly data she provides to various users), (b) reconsideration of what is included in the minimum dataset, and (c) whether or not to do crosschecks on incomplete charts.
10. There is confusion about TISS elements {{TISS w Nr|Spontaneous breathing via ETT without PEEP/CPAP, with or without supplemental O2 (TISS Item)}} and {{TISS w Nr|Supp O2 though any device, delivered via nose, mouth, ETT or trach (TISS Item)}} .  
*We did not get to this today, '''will discuss at next Task meeting''':
*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'''.
**Considerations include: making reports more easily interpretable for users; reducing complexity/variation in reporting; and reducing queries back to collectors due to crosschecks on incomplete charts.
**Currently, Julie will report on an indicator once it is “mostly complete”, which due to how data is being collected during the pandemic, is at different times for different indicators.
**Allan proposed that in the future all reporting be done only on complete charts (note we are approximately 3 months behind on ICU collection completion) and that crosschecks only be done on complete charts.  Tina to implement this.  Furthermore that alongside the results that for the time period in question Julie also routinely include the % of patients not included due to the charts being incomplete.  Julie and Allan discussed this separately on Nov 5 and Julie has a good solution for reporting, wherein she will report both the % of missing patients, and % of missing patient-days.
**As the current listing for the minimum dataset includes a potpourri of items that are really not “minimum”, Tina will modify that delineation and remove such items.


7. Item from a separate, ongoing discussion between Tina, Allan and Julie relating to creating Wiki page [[Data User Portal for the Manitoba Critical Care and Medicine Databases]].
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'''.
*Tina/Julie to create some explanatory text for the pages: [[Auto Data Dictionary]], [[Projects]], [[Indicators]] and [[Created Variables CC table]].
*'''Allan to improve the section of this page on “What Constitutes a Single Record of Data”'''.


8.  Julie reported that Dan is working on what amounts to a “data sharing agreement” having to do with data security and ethical use, which those requesting data will need to sign.
12. '''Next meeting February 3, 2022 at 11 am'''.
*Tina has written down some issues which she feels should be addressed in such an agreement and sent it to Allan Dec 1. '''Allan will communicate about it with Dan'''.
*The question arose about whether users should be able to use data for purposes beyond/other than what their request indicated.  We agreed that in the research domain the answer is “no”, and that to do so users would be required to go back to REB to get approval of the additional analyses/purposes.  However, it was not so clear in relation to QA and administrative purposes --- '''Allan will discuss with Bojan and Dan'''.


== 2021... ==
== 2021... ==

Revision as of 13:14, 2022 January 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.
Hemothorax or hemopneumothorax, nontraumaticJust wondering whether this code could be combined with iatrogenic causes similar to the guideline for:

Guideline for Iatrogenic Pneumothorax

According to our general rule of not coding iatrogenic events as traumas, code an iatrogenic pneumothorax as


Iatrogenic, puncture or laceration, related to a procedure or surgery NOS

Plus the most appropriate of the following;

Pneumothorax, tension, nontraumatic

Pneumothorax, nontension, nontraumatic

Pneumothorax, nontraumatic, NOS

Thanks, Pamela Piche 08:55, 2024 March 19 (CDT)

  • Allan made the initial entry of not to use this as an iatrogenic or trauma code in 2017, so let's discuss this at TASK Lisa Kaita 15:03, 2024 April 5 (CDT)
5 April 2024 20:03:05
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
Myocardial infarction, acute (AMI), NOSICD 10 has this code for STEMI:

2024 ICD-10-CM Diagnosis Code I21.3

  • ST elevation (STEMI) myocardial infarction of unspecified site that includes transmural (Q wave) infarction

ICD 10 has this code for NSTEMI:

2024 ICD-10-CM Diagnosis Code I21.4

  • Non-ST elevation (NSTEMI) myocardial infarction that includes Nontransmural myocardial infarction NOS

Would it be less labor intensive for collectors to be able to use these codes instead of MI codes dependent upon development (or not) of Q waves as this is problematic to determine. Thank you, Pamela Piche 07:49, 2024 April 5 (CDT)

  • I have added this to TASK, in 2019 ICD 10 did not have STEMI/NSTEMI codes, now in the 2024 version they do, I agree with Pam can we switch to the new codes? Lisa Kaita 15:10, 2024 April 5 (CDT)
5 April 2024 20:10:42
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)
    		• 8 April 2024 16:27:53

    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 - 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.

    2021...

    Also see Task Team Meeting - Rolling Agenda and Minutes 2021

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