Task Team Meeting - Rolling Agenda and Minutes 2023

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List of items to bring to task meeting

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

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Sedative or hypnotic, withdrawal How do we code muscle relaxant ie. baclofen withdrawal? 2024-06-11 7:00:43 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)
2024-04-08 4:27:53 PM
Stroke, NOS we need clarification on when to use this code, eg. if there is a history where it says a history of stroke, or if on CT they comment remote lacunar infarcts? Lisa Kaita 12:01, 2024 April 17 (CDT) 2024-04-17 5:01:53 PM
Template:CCI Guideline Vasoactive Drugs TISS
  • Can you please clarify if we are to include labetalol, as the above instruction would have us exclude it? Lisa Kaita 09:26, 2024 May 9 (CDT)
    • Or could "negative" in this context mean that they are lowering ones? Ttenbergen 07:57, 2024 May 15 (CDT)
  • 2024-05-15 12:57:05 PM
    Vasoactive drug IV continuous-multiple simultaneous (TISS Item)
  • Can you please clarify if we are to include labetalol, as the above instruction would have us exclude it? Lisa Kaita 09:26, 2024 May 9 (CDT)
    • Or could "negative" in this context mean that they are lowering ones? Ttenbergen 07:57, 2024 May 15 (CDT)
  • 2022-03-16 9:26:08 PM
    Vasoactive drug IV continuous-single (TISS Item)
  • Can you please clarify if we are to include labetalol, as the above instruction would have us exclude it? Lisa Kaita 09:26, 2024 May 9 (CDT)
    • Or could "negative" in this context mean that they are lowering ones? Ttenbergen 07:57, 2024 May 15 (CDT)
  • 2022-03-16 9:27:20 PM

    Also see Task Team Meeting - Rolling Agenda and Minutes 2022

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    ICU Database Task Group Meeting – August 31, 2023

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

    1. Question was raised about dealing with Neuro, Nephro or Onc patients who start out in ED and then are admitted to a Medicine ward. Allan modified the Definition of a Medicine Laptop Admission to clarify this.

    2. Next meeting at 11 am on September 28 at 11 am.

    ICU Database Task Group Meeting – July 27, 2023

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

    1. Question was raised specifically about Heart and/or coronary arteries, diagnostic imaging, abnormal, specifically about how/when to use it. But in fact this issue applies to all the ICD10 codes relating to signs and symptoms (R00-R94, inclusive).

    • These codes are to be used only when such a sign or symptom (which include diagnostic testing of all sorts) is present but without a specific diagnosis code available. For example, if a cardiac cath is abnormal showing CAD, then one would not code Heart and/or coronary arteries, diagnostic imaging, abnormal but might instead code Coronary artery disease, chronic. As this applies to all such codes, Allan will ask Tina to make sure that a template is applied to all the specific codes indicating this.

    2. Question was raised about how to code syphilitic infection of the globe of the eye. Answer is Endophthalmitis, infectious with the organism being Treponema pallidum.

    3. Next meeting at 11 am on August 30, 2023.

    ICU Database Task Group Meeting – June 22, 2023

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

    1. Transition to Database Server#Shared Health - Allan updated the group about work being pursued for both possible options, i.e. through Digital Health, and through the University of Manitoba. The former is further ahead in both planning and implementation, although no final decision has been made.

    2. ABG Data - No additional followup on last report from Heather Smith about working to get ABGs at Grace Hospital to be included in the Lab Info System (LIS).

    3. Allan reported that there is a plan to add the Brandon ICU to our ICU database. The biggest impediment is funding, but leadership in Brandon hopes this will come through in 2024 or 2025.

    4. As regards Thoracic endovascular aneurysm repair the question arose of whether the Action should be "Repair" or "Excision with reconstruction/replacement". After reading more about the procedure, Repair is correct. Allan has modified the Wiki page to explain this.

    5. Question was asked how to code the MAZE procedure for atrial fibrillation. As it is a subtype of Atrial Ablation, it should be coded the same way (using Destruction code - wiki has been updated).

    6. Question was asked about why we record each GI endoscopy but only the first ERCP (endoscopic retrograde cholangiopancreatography). After discussion we agreed that we SHOULD record all ERCPs. Tina has changed the Wiki and CCMDB accordingly.

    7. Question was asked about the presence on List of CCI procedures we don't code of "Lavage, Therapeutic". After discussion we clarified that while we should code all exploratory laparotomies (which by definition must include taking some sort of look inside the peritoneum), we will not code Theapeutic Lavage which involves serially instilling and draining fluid.

    8. Question was asked about whether to code multiple skin graft procedures. Answer is Yes.

    9. Regarding skin grafting, it was clarified that the organ used should be (T) Skin, NOS/

    10. Question was asked about how to code a primary malignancy of 1 paired organ (e.g. lung, breast, etc) that is metastatic to the other in the pair. Answer was to code both the primary and the metastatic codes, and link them together. 'Tina has updated Template:ICD10 Guideline Combined dx metastasis primary and removed the question from Lung, metastatic malignancy to it (also code primary site)

    11. Question was asked about how to code nosocomial influenza pneumonia. After discussion we agreed that it should have 2 codes, both as Acquired Diagnosis: (a) Influenza pneumonia (which has an implied organism) and (b) Nosocomial infection, NOS with the organism being Influenza virus NOS -- should almost never be used. But since these 3 codes cannot be all linked together (due to Influenza pneumonia doesn't allow an organism), 'a' and 'b' should have different priorities.

    12. Next meeting July 19 at 11am.

    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. ABG Data - 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. After extensive discussion we came to:

    • These are tricky because it is pretty common that before the primary (proven type) has been proven, that a patient is put on multiple types of antimicrobials -- e.g. it's flu season and patient comes in with a diffuse infiltrate and signs of infection, and the ED starts anti-viral + antibacterial drugs. What often happens is that in the next few days the team decides it was only influenza and stops the antibiotics. As it would be very very uncommon to treat a true bacterial pneumonia for <7 days, in THIS case we will use the guideline to code a bacterial pneumonia if the antibacterial agent was given for >4 days or the patient died before the 5th day of antimicrobials.
    • As per our usual practice, we will consider a diagnosis as present if the clinical team thinks it's present and are treating it, with the exception (as directly above) that the team initially treated for the possible 2nd type of pneumonia but then decided it likely was NOT present and stopped those agents.
    • Regarding use of Pneumonia, NOS versus any of Pneumonia, bacterial, Pneumonia, viral, Pneumonia, fungal/yeast
      • Pneumonia, NOS should be used when there is a presumed pneumonia but the team is unsure what kind of organism is involved (bacteria, virus, fungus). So simply not having an organism from culture doesn't necessarily mean that Pneumonia, NOS should be used. If, for example, the team is assuming that it's a bacterial pneumonia (and treating it as such), but doesn't know which bacterium, then use Pneumonia, bacterial + Infectious organism, unknown

    5. Julie related that Heather Smith was seeking information going back to 2015 about surgery service patients admitted to Grace ICU. While we do have information about patients who came to ICU from OR/PACU, we don't readily know which surgery service patients came to ICU directly from a surgical ward. Allan emailed Heather to let her know what we can, and can't get for her.

    6. Lisa queried how to code creation of a colostomy and whether it involved (T) Surgically Constructed Sites in Digestive and Biliary Tract. Answer is no, colostomy is coded by (T) Large Intestine with Bypass.

    7. Next Task meeting May 16, 2023 at 1pm

    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