Task Team Meeting - Rolling Agenda and Minutes 2024

List of items to bring to task meeting

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Intracardiac (mural) thrombosis, not related to MI	I have a pt with an LV thrombus after anterior MI, this code says not related to MI, when I look up ICD 10 it says to use this code I51.3 but the ICD 10 diagnosis is Intracardiac thrombosis, not elsewhere classified. Should we change the name of this code? or code the LV thrombus differently and if so how? Lisa Kaita 10:08, 2024 July 12 (CDT)	2024-07-12 3:08:52 PM
Pneumonia, ventilator-associated (VAP)	Does this rule still apply since we no longer require an organism for a VAP, if someone is admitted with a CAP and later meets the criteria with the same bug, with our new guidelines would this not be considered a VAP? Lisa Kaita 11:16, 2024 July 24 (CDT) This will be carried over to next TASK (Sept12, 2024) Lisa Kaita 12:21, 2024 August 1 (CDT)	2024-08-04 12:28:34 PM

Also see Task Team Meeting - Rolling Agenda and Minutes 2022

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ICU Database Task Group Meeting – January 11, 2024

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

1. Followup discussion about patients who have different or otherwise contradictory postal codes during a single episode of care involving hospital-to-hospital transfers. There are 2 kinds of these:

• FIRST: one hospital record indicates a valid postal code while the other has "na" for the code. There are 2 possible scenarios here:
  • (1) We note that the postal code field should contain "na" when the patient is homeless, and that homelessness per se is a response option in the data field of pre-admit location.
    • It became clear in discussion that the collectors spend considerable effort validating homelessness, so based on that we decided that when it is present in the pre-admit location field that we will take that as correct, and that all postal codes in that episode of hospital care (i.e. across the hospital-to-hospital transfers) should be fixed to be "na" and all the pre-admit locations should be listed as "homeless".
    • Furthermore, Julie will go back and make it so all past records meet this new rule as well.
    • Lisa will alter the Wiki so that it no longer says that for homeless patients who are living at a shelter, to list the postal code of the shelter. Instead it will say to list that postal code as "na".
  • (2) None of the pre-admit locations were "homeless". We decided when this occurs, Julie/Pagasa will work to discern the true situation.
• SECOND: both hospital records list valid, but different, postal codes.
  • In discussion it was clear that there are numerous possible explanations for this and so we decided that when this occurs, Julie/Pagasa will work to discern the true situation.

2. Followup on item#3 in the November 2023 minutes, in regards to patients who present to ED at a given hospital and have ICU team involvement while in ED, but subsequently either die in ED or are transferred to another hospital (e.g. from Grace ED to Gold surgery at HSC). Specifically the question is about if/how to include them in the ICU database, and if so exactly when to code the ICU team as beginning to provide care.

• The plan at that meeting was to start and figure out how to proceed at Grace, and thereafter to decide what to do for St. B and HSC. To get going on that, Barret was going to speak to Heather Smith.
• As he was not able to attend today's meeting, Allan sent Barret an email today to inquire about that discussion. Awaiting reply.

3. About the dramatic and sustained increase in only Stage 1 and 2 decubitus ulcers starting January 2022, and only at Grace.

• Gail & Mindy reported that although there had been a change in the ICU flowsheet at Grace, that this occurred before 2022, and that furthermore, the part of the new flowsheet recording decubs was identical to the old flowsheet.
• In discussion we wondered whether this issue might be due to a change in education/guidelines for the Grace ICU nurses about identifying and recording early stage decubs. To try and get at that, Allan will directly contact the Nurse Educator at Grace ICU, Chantal Packulak.

4. Question about rationale and guidance around use/nonuse of vital signs during cardiac or pulmonary arrest for the APACHE values.

• Allan explained the rationale for this, and augmented the Wiki page on APACHE values to explain it.
• Beyond that, to operationalize the rule of NOT using any vitals from an arrest, the rule (which Allan included in the augmented Wiki page) will be that one can use vitals from all sources EXCEPT the Code Blue recording sheet.

5. Question about interfacility transfers between Hospital A and Hospital B when the patient is in a procedure location (e.g. cath lab, OR) in Hospital B prior to admission to Hospital B.

• After discussion we agreed that: (a) the discharge time from Hospital A should be when the patient left to go to the procedure location, (b) the admit time to Hospital B should be when the patient was actually admitted there after the time in the procedure location, (c) in order to correctly identify EPISODES of care (i.e. with direct hospital-to-hospital transfer) she will need to look not only at the set of locations, but also the Prior Inpatient Location field. Lisa and Julie will update the Wiki accordingly.

6. Issue with the ADT assignments at St. B.

• Specifically, when patients go: ward area --> ICU-type area of the same service
  • This could be:
    • Cardiac surgery ward --> OR --> CICU: and on cardiac surgery for all this
    • Cardiology ward --> ACCU: and on cardiology for all this
    • even sometimes Medicine ward --> ICMS
  • The problem is that the admitting office does not change the service and so in Cognos they don't show up as having come to an ICU.
  • What SHOULD happen is that when these patients go to an ICU, that the service should change to "ICU/Cardiac surgery" or "ICU/Cardiology" or even "ICU/Medicine".
• Allan will contact Kim LeBlanc, head of admitting at St B to discuss this.

7. Next meeting is February 22, 2024 at 11 am

ICU Database Task Group Meeting – November 23, 2023

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

1. Regarding the prior idea to expand our ICD-10 coding to include ALL actual ICD-10-CA codes.

• Lisa reports that while this was generally supported in talking to the data collectors, there was also a sense that we should delay further discussion on this until a more opportune time.

2. Julie reports that she has noted some patients who have different or otherwise contradictory postal codes during a single episode of care.

• We note that postal codes derive from the ADT/Cognos system.
• As it's unlikely that more than a trivial number of patients are moving residences over such a short timespan, we need more details about this and Julie will obtain such information for us to discuss at the next Task meeting.

3. An issue arose about patients who present to ED at a given hospital and have ICU team involvement while there, but subsequently either die in ED or are transferred to another hospital (e.g. from Grace ED to Gold surgery at HSC). Specifically the question is about if/how to include them in the ICU database, and if so exactly when to code the ICU team as beginning to provide care.

• This question is complicated by a wide range of types of care provided by the ICU team in ED. It continuously spans from consultation with small actual involvement, all the way up to functionally taking over care while in ICU. While the latter should be included in the ICU database, the former should not. And of course there's everything in between.
• Part of this is that putting in an ICU admission for such a patient in ED results in the ICU team having to write a discharge summary and transfer note -- which is paperwork we'd seek to avoid.
• For Grace we discussed 2 possible solutions, both involving the ICU attending making a judgement for ED patients in whom they are contributing to care whether or not to count that person as "being on the ICU service" even if she/he never gets to an ICU in that hospital:
  • Actually put in an ICU admission
  • Don't put in an ICU admission, but record such patients in a separate portion of the ICU logbook.
  • Barret will discuss this with Heather Smith and report back at the next Task meeting.
• After we come up with a solution for Grace, we will need to discuss solutions for HSC and St. B.

4. About coding decubitus ulcers.

• We validated that when an acquired diagnosis should be entered for both de novo decubs that develop in ICU, and for progression of pre-existing decubs (e.g. from Stage 2 to Stage 3).
• We also looked at data on ICU-acquired decubs from Grace over time. This arose because the rate of such ulcers developing or worsening in the Grace ICU seem much higher than in other ICUs. It is not clear whether Grace is high or other ICUs are low. Upon further assessment, these rates rose precipitously from last quarter of 2021 to the 1st quarter of 2022. Most likely this coincides with some change in how decubs are recorded.
  • Gail will seek information about if/how such changes in recording of decubs may have happened from Jan 2022 onwards.

2023...

Also see Task Team Meeting - Rolling Agenda and Minutes 2023