Task Team Meeting - Rolling Agenda and Minutes 2023: Difference between revisions

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Also see [[Task Team Meeting - Rolling Agenda and Minutes 2022]]
Also see [[Task Team Meeting - Rolling Agenda and Minutes 2022]]
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== ICU Database Task Group Meeting – April 19, 2023 ==
*Present: Allan, Julie, Tina, Pagasa, Mindy, Michelle, Gail, Barret, Val, Pam
*Minutes prepared by: AG
*Action items in BOLD
1. [[Transition to Database Server#Shared Health]] - '''Nothing new''' about either of the possible alternative options for hosting the database.
2. [[Controlling Dx Type for ICD10 codes]] -- We agreed that this large task would be difficult, questionable, and not worth the effort. 
3.  Followup about trying to get ABGs at Grace Hospital to be included in the Lab Info System (LIS).
*Allan reported that '''Heather Smith is working to arrange a Zoom meeting of the relevant parties.'''
4.  Followup on if/how to deal with proven cases of influenza who are treated also with antibiotics for ''possible'' superimposed bacterial pneumonia. 


== ICU Database Task Group Meeting – Feb 2, 2023 ==  
== ICU Database Task Group Meeting – Feb 2, 2023 ==  

Revision as of 12:25, 2023 April 19

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}}

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wiki page question Last modified
wiki page question Last modified
Iatrogenic, mechanical complication/dysfunction, internal prosthetic device or implant or graft NOS At 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) 2024-03-20 5:37:32 PM
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)
2024-03-25 6:59:38 PM

Also see Task Team Meeting - Rolling Agenda and Minutes 2022

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ICU Database Task Group Meeting – April 19, 2023

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

1. Transition to Database Server#Shared Health - Nothing new about either of the possible alternative options for hosting the database.

2. Controlling Dx Type for ICD10 codes -- We agreed that this large task would be difficult, questionable, and not worth the effort.

3. Followup about trying to get ABGs at Grace Hospital to be included in the Lab Info System (LIS).

  • Allan reported that Heather Smith is working to arrange a Zoom meeting of the relevant parties.

4. Followup on if/how to deal with proven cases of influenza who are treated also with antibiotics for possible superimposed bacterial pneumonia.



ICU Database Task Group Meeting – Feb 2, 2023

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

1. Transition to Database Server#Shared Health - Nothing new about either of the possible alternative options for hosting the database.

2. Controlling Dx Type for ICD10 codes

  • We had additional discussion on whether this task is worth doing
  • Collectors generally expressed that they're not very concerned that errors occur more than rarely in coding the type/bin in which a diagnsosis belongs. However, there was general agreement that we should try to get more data on this issue, and re-discuss it next time.
  • Accordingly, Julie will generate a table where for each ICD10 code she identifies the total % that were coded in each of the 3 bins. We will use this as a first step to identify the magnitude and nature of this problem.

3. Followup item about trying to get ABGs at Grace Hospital to be included in the Lab Info System (LIS).

  • Allan reported that just today Heather Smith emailed that she's working on it. We'll follow up and if they're willing, Allan will talk to Dr. Soroko about getting it implemented.

4. New item: Many or most proven cases of influenza are treated also with antibiotics for possible superimposed bacterial pneumonia. The question is whether or not to also code bacterial pneumonia in these cases.

  • Discussion highlighted that in fact most patients presenting with proven influenza respiratory infection do NOT have bacterial pneumonia superimposed. Evidence from pandemics indicates that:
    • The most common bacterial causing superinfection are Staph aureus and Strep pneumoniae
    • Such superinfection is seen in a much greater fraction of those with severe manifestations -- e.g. in the 2009 H1N1 pandemic it's been estimated that 25-50% of severe cases had bacterial superinfection
    • Superinfection, when it occurs, generally occurs at least a few days after initial presentation
  • We decided that before deciding what to do about these cases, that Allan will see if the CDC has a good case definition for bacterial superinfection in influenza ---> There isn't one and neither could he find one elsewhere in the medical literature.
  • We'll discuss this further at the next meeting, but given that at least a substantial minority (25-50%) of those with severe manifestations of influenza pneumonia do have bacterial superinfection, the choice that's most consistent with our general philosophy of accepting a diagnosis given by the medical team, is to code them as bacterial pneumonia if the team gives antibiotics.

5. New item: If a nontraumatic brain injury (of any cause/type) is accompanied by a small "shift" seen on brain imaging, should one also code Brain compression, including herniation?

  • Answer is "yes". Allan has altered the Wiki accordingly.

6. New item: How to code surgical amputation of a part of a leg (e.g. toes, foot).

  • Answer: Indeed we have not included in CCI the subparts of the lower limb, but as no user has ever asked for this level of detail, we agreed to stick with just having (D) Leg, NOS.

7. New item: Clarification of multiple subcategories of COVID.

  • It should not be that both asymptomatic COVID and symptomatic COVID are listed as admit diagnoses --- if so only keep the symptomatic one
  • Both asymptomatic COVID and symptomatic COVID can be listed as acquired diagnoses, but only if asymptomatic is listed first and the 2 have different dates.

ICU Database Task Group Meeting – Jan 11, 2023

  • Present: Allan, Gail, Julie, Michelle, Mindy, Stephanie, Tina, Val, Pagasa, Mailah
  • Minutes prepared by: AG
  • Action items in BOLD

1. Transition to Database Server#Shared Health - Nothing new about either of the possible alternative options for hosting the database.

2. Controlling Dx Type for ICD10 codes - Regarding the task to improve data collector diagnosis assignment into the 3 "bins" of admission diagnosis, acquired diagnosis and comorbid diagnosis.

  • Lisa indicated that for a first pass on this, she will distribute all the codes among all the collectors.

3. New item: Clarification of Pulmonary emphysema or bullous disease without COPD. Allan modified this Wiki entry to make it clearer.

4. New item: Regarding the code Sudden cardiac death (and died)

  • After discussion we recognized that we have no need to specifically code patients' cause of death. We know it occurred by virtue of the Dispo field. Thus we agreed to remove this item from the list of ICD-10 codes, and to have Julie go into all records where it has been recorded and remove it. Allan modified the Wiki page also.

5. New question: It was noticed that an error occurs if a diagnosis of Influenza is recorded (which is an implied bug) and one attempts to combine it with a Nosocomial problem code.

6. Followup item from long ago: Seeking to get ABGs at Grace Hospital to be included in the Lab Info System (LIS).

  • The last time we tried for this, in 2015, the resp therapy group at Grace was not interested in being required to manually logging this information into LIS, as IS done at HSC and St. B.
  • We think they may be more open to it now -- so today Allan emailed Heather Smith, asking her to raise it with them.
  • If they indeed are willing, Allan will talk to Dr. Soroko about getting it implemented.

7. New item: Uncertainty of when/how to use Complication of labor and delivery, NOS

  • As our database is only for adult patients, this code should not be used to indicate such a complication for a newborn. For example: During hospitalization, such a complication occurs, but it only affects the newborn and has no medical consequence for the mother --- do NOT use this code.
  • Of course, for some such complications when the newborn with a complication becomes an adult, that problem persists, e.g. Fetal Alcohol Syndrome. If that adult is then admitted, it is the specific problem (such as Fetal Alcohol Syndrome) that should be listed as a Comorbid Diagnoses -- again you would NOT code Complication of labor and delivery, NOS.
  • The only time Complication of labor and delivery, NOS would be coded is when the mother herself incurs a complication of labor or delivery, AND there is not a more specific code for the complication she suffered.
  • Allan modified this Wiki page for clarity.

8. New item: Clarification of when/how to use Oral mucositis

  • This code is for widespread or diffuse oral mucus membrane involvement -- as often occurs after some chemotherapies, and a few other causes.
  • Do not use it for localized oral lesions or involvement in just a part of the oral mucosa. In such a case code the specific cause if known, and otherwise use Disorder of oral mucosa (mouth, lips, tongue), NOS.
  • Allan has updated the Wiki to reflect this.

2022...

Also see Task Team Meeting - Rolling Agenda and Minutes 2022