Task Team Meeting - Rolling Agenda and Minutes 2025

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Chronic Health Facility This issue raised a problem with medicine data recently, and we will review again if this needs to be coded more granular after all. Adding this to put it on the agenda. 2025-05-20 3:58:12 AM

Also see Task Team Meeting - Rolling Agenda and Minutes 2024

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ICU Database Task Group Meeting – May 14, 2025

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

1. Continued discussion about coding decubitus ulcers

  • After discussion with Andrea in SICU, it was agreed that we will add to coding of decubiti the location, simply divided as: sacral, heel or other
  • After discussion, we agreed that we will do so by adding an additional digit to the L89 family of codes, so that single codes will indicate both stage and location.
  • We also add a code L89.6 for "Pressure-induced deep tissue damage", distinct from Stage IV decubitus ulcer, defined as:
    • A localized area of persistent non-blanchable deep red, maroon, or purple discoloration, that may present with intact skin or as a blood-filled blister. The depth is not immediately clear and it can evolve into a full-thickness wound or develop eschar. It is diagnosed based on color changes and tissue consistency, not initially by depth as that is not immediately clear.
  • Allan proposes that the L89 family now include:
    • L89.0.1 Decubitus (pressure) ulcer, Stage I (surface reddening), of sacral area
    • L89.0.2 Decubitus (pressure) ulcer, Stage I (surface reddening), of heel
    • L89.0.3 Decubitus (pressure) ulcer, Stage I (surface reddening), of other area
    • L89.1.1 Decubitus (pressure) ulcer, Stage II (to fascia, just under skin), of sacral area
    • L89.1.2 Decubitus (pressure) ulcer, Stage II (to fascia, just under skin), of heel
    • L89.1.3 Decubitus (pressure) ulcer, Stage II (to fascia, just under skin), of other area
    • L89.2.1 Decubitus (pressure) ulcer, Stage III (deep, to but not including muscle), of sacral area
    • L89.2.2 Decubitus (pressure) ulcer, Stage III (deep, to but not including muscle), of heel
    • L89.2.3 Decubitus (pressure) ulcer, Stage III (deep, to but not including muscle), of other area
    • L89.3.1 Decubitus (pressure) ulcer, Stage IV (involves bone), of sacral area
    • L89.3.2 Decubitus (pressure) ulcer, Stage IV (involves bone), of heel
    • L89.3.3 Decubitus (pressure) ulcer, Stage IV (involves bone), of other area
    • L89.6.1 Pressure-induced deep tissue damage, of sacral area
    • L89.6.2 Pressure-induced deep tissue damage, of heel
    • L89.6.3 Pressure-induced deep tissue damage, of other area
    • L89.9.1 Decubitus (pressure) ulcer, stage not indicated, of sacral area
    • L89.9.2 Decubitus (pressure) ulcer, stage not indicated, of heel
    • L89.9.3 Decubitus (pressure) ulcer, stage not indicated, of other area

2. Template:ICD10 Guideline Pneumonia: Continued discussion in relation to identifying bacterial superinfection of viral pneumonia

  • Julie showed us data from 2019 to 2024 about acquired bacterial pneumonias (including but not limited to VAP) coded <14 days after admission with viral pneumonia (including but not limited to COVID).
    • Pre-COVID there were few
    • Once COVID began these increased 10-50-fold in the pre-vaccine era
    • After COVID vaccine became available, these fell, but still much higher than pre-COVID
    • With implementation of the 14-day rule in October 2024, these fell precipitously.
  • After discussion, including offline discussion with Jen Ziegler, we will make a single exclusion to the 14-day rule, specifically, a bacterial pneumonia may be coded in <14 days of admission with an admit diagnosis of a viral pneumonia.
Someone will need to update Template:ICD10 Recent Previous Pneumonia and/or Template:ICD10 Guideline Pneumonia with this decision. Ttenbergen 22:27, 19 May 2025 (CDT)
  • SMW


  • Cargo


  • Categories

3. Chronic Health Facility⚓ - Continued discussion about whether or not to try and identify -- as "admit from" and "dispo" locations -- the subportions of Deer Lodge and Riverview.

  • After discussion with Bojan, given the difficulty, we will NOT do so. Thus we will leave those sites as single locations, not subdivided.

4. Lisa reported that the updated electrolyte disturbance coding rules (see prior Task Group Meeting) have been implemented.

5. New topic -- coding Homelessness.

  • We previously had a code (Z59.0) for Homelessness. As it duplicated the concept and coding for Pre acute living situation, we had eliminated it.
  • Tina reported that in the project she's doing with Dan Roberts working to better deal with discharge planning to help remove "downstream" limitations to moving people along the ED to inpatient continuum, the issue of homelessness has become apparent in multiple forms. One of these are people who were living in some sort of group home or assisted living, but were sent to hospital because their needs came to exceed the capabilities of those prior residences, i.e. in effect the person lost their housing upon hospitalization. There was discussion of whether that can actually be called homelessness before hospital discharge.
  • Tina will arrange a meeting between Allan, Dan and her to continue this discussion.
      • One option is to re-instate Z59.0 but only allow it as an acquired diagnosis and only if, in fact, upon hospital discharge the patient is actually homeless. However, this will not deal with the discharge planning issue of problems with housing that are identified pre-discharge.

6. Brandon Hospital ICU Data Collection Setup⚓ - Lisa reported that a 0.6 FTE data collector has been approved for Brandon hospital, beginning January 2026.

7. Re-platforming to UM MedIT undetermined platform - Allan reported that he emailed Kiran Kaur to ask about the status of our database replatforming request to Med-IT. He has not heard back yet.

8. Next meeting June 18 at 11 am Central time.

ICU Database Task Group Meeting – April 8, 2025

  • Present: Allan, Lisa, Julie, Jen, Tina, Pagasa, Mailah, Michelle, Mindy, Barret, Mailah, Joanna
  • Minutes prepared by: AG
  • Action items in BOLD

1. Template:ICD10 Guideline Pneumonia - Continued discussion about nosocomial bacterial superinfection of viral pneumonia

  • Julie showed us numerators and denominators, pre and post the 14-day rule took effect, of acquired Pneumonia, bacterial codes.
  • For the next meeting she will limit this output to those records in which there was any sort of viral pneumonia code (including COVID) at admission

2. s_dispo tableChronic Health Facility⚓ - Update about whether we should categorize locations (dispo, previous inpatient location, immediately pre-admit location) as general locations or as a specific location

  • Bojan requested specific identification of admission from the various different segments of River View and Deer Lodge.
  • HOWEVER, through discussion we recognized that we are highly limited in our ability to do so, specifically:
    • Identification that the patient came from River View or Deer Lodge is NOT on Cognos -- though it can be identified from the admit and transfer notes.
    • It is NOT easy to identify which segment the patient came from, or even which nursing unit.
  • Allan sent an email to Bojan, let him know about this, and asked how he'd like to proceed.

3. Template:ICD10 Guideline Decubitus Ulcer: Update regarding SICU's desire for more details about decubitus ulcers

  • After further discussion we recognized that we need more details of what bits of information SICU is seeking -- among: site(s); stage(s); location(s); number(s)
  • Lisa will work to arrange a meeting with Andie, herself and Allan- booked for May 14, 2025Lisa Kaita 06:19, 9 April 2025 (CDT)

4. More discussion about coding electrolyte disturbances. After extensive discussion we decided that we will alter our paradigm for coding these:

5. Next meeting May 14 -- Lisa will send out an e-vite

ICU Database Task Group Meeting – February 27, 2025

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

1. Template:ICD10 Guideline Pneumonia - Continued discussion about nosocomial bacterial superinfection of viral pneumonia

  • Julie showed us the numbers, pre and post the 14-day rule took effect, of acquired Pneumonia, bacterial codes. However, as these intervals were quite different, to interpret them we must have the denominators also. Julie will prepare that data for our next Task Group meeting.

2. s_dispo table/Chronic Health Facility⚓ - Update about whether we should categorize locations (dispo, previous inpatient location, immediately pre-admit location) as general locations or as a specific location

  • Allan reported that Bojan indicated:
    • No need to identify specific LTC facilities
    • They do want to specify the different components of River View and Deer Lodge. Lisa will work on doing this, with Tina then to implement them.
  • see Chronic Health Facility also had discussion at JALT

3. Template:ICD10 Guideline Decubitus Ulcer: Update regarding SICU's desire for more details about decubitus ulcers

  • Lisa was unsuccessful so far in contacting SICU nursing leadership about how they would want to handle multiple decubs in a given site, AND how long they would want such a temp project to last. She will continue to work on that.

4. We had extensive discussion about whether or not to track (as ICD-10 diagnosis codes) specific electrolyte abnormalities.

  • Discussion included:
    • We DO need to at the very least be able to code these as admit diagnoses
    • As acquired electrolyte abnormalities are very common, esp in ICU patients, there may be less imperative to track these as acquired conditions. However, there are certainly cases where they are highly relevant as acquired diagnoses.
    • A relevant simplification from how we currently track these would be to remove the "double thresholds", i.e. situation where we have different lab value thresholds depending on whether or not the patient got treated for the electrolyte abnormality.
  • Thus, we decided to continue to track these 6 types of ICD-10 codes as both admit and acquired diagnosis, but to remove the double thresholds. WIKI has been updated Lisa Kaita 15:53, 28 February 2025 (CST)

5. Past history of Covid-19 infection: Allan reported that after discussion with Bojan, we CAN STOP collecting past history of covid-19 infection (U07.5) Retired this code Lisa Kaita 15:53, 28 February 2025 (CST)

6. Template:CCI Guideline Transfusions: New item: It was identified that different sites include/exclude transfusions in different locations, e.g. OR.

  • After discussion we agreed that going forward we will include ALL transfusions, done in any location, for a patient currently "assigned to ICU or ward". Updated the wiki Lisa Kaita 15:53, 28 February 2025 (CST)

7. Next meeting march 27 at 11 am Central Time.

ICU Database Task Group Meeting – January 29, 2025

  • Present: Allan, Lisa, Julie, Jen, Pagasa, Hardeep, Val, Gail, Mailah, Joanna
  • Minutes prepared by: AG
  • Action items in BOLD

1. Continued discussion about nosocomial bacterial superinfection of viral pneumonia

  • Jen reported on her literature review:
    • It is not uncommon -- up to 20-40% depending in the virus
    • It commonly occurs <14 days after viral onset, often within 7-10 days
    • It is difficult to identify, and the diagnosis very likely has many false-positives
  • We generally agreed we should be able to track it, and that it would be a exception to the "14-day rule" for VAP. Possible ways to track it include:
  • Before making a final decision, Julie will try and estimate the number of them comparing 2023 with 2024 (before vs. after the 14-day rule took effect)

2. Update about whether we should categorize locations (dispo, previous inpatient location, immediately pre-admit location) as general locations or as a specific location

  • Allan will followup with Bojan about this

3. Update regarding SICU's desire for more details about decubitus ulcers

  • First, we agreed to add a new sub-code: L89.96 Decubitus (pressure) ulcer, pressure-induced deep tissue damage
  • Lisa clarified that SICU desires to subdivide decubs by site into 3: posterior, heel, others
    • Lisa will talk to SICU nursing leadership about how they would want to handle multiple decubs in a given site, AND how long they would want such a temp project to last

4. New issue -- certain lab abnormalities, particularly Hypoalbuminemia, severe and Hypophosphatemia are so common that perhaps we should modify their thresholds, or eliminate them

  • We agreed that prior to further discussion of this, Julie will identify the fraction of all patients (separately in ICU and wards) with those codes.

5. Update on whether we can we stop collecting past history of covid-19 infection (U07.5) - Allan to email Bojan

Last year's last meeting, included for continuity: ICU Database Task Group Meeting – December 4, 2024

  • Present: Allan, Lisa, Julie, Jen, Mindy, Pagasa, Hardeep, Allyson, Val, Gail, Mailah, Dan, Tina
  • Minutes prepared by: AG
  • Action items in BOLD

1. Dan explained a modification/expansion of the ward Overstay project

  • Currently we have a "transfer ready" date flag(Transfer Ready DtTm tmp entry) -- which indicates when not only the medical team, but all involved ancillary services deem the patient cleared to leave the hospital
  • We are adding a new "medically ready" flag (Project MR) -- which indicates when the ward medical team considers the patient able to leave hospital. Dan explained that he is working with the sites and the ward physicians to ensure that they identify this timepoint in the notes and/or orders.
  • Also, we have begun collecting the existence of ancillary health consults on wards (Project AHC)

2. Update on Pneumonia, ventilator-associated (VAP)‎‎ coding

  • Lisa related that at the recent meeting of all data collectors, Jen presented the current VAP coding criteria, including the CDC 14-day blackout period for identifying subsequent pneumonias of any type
  • After discussion, we agreed to consider ECMO patients for VAPs -- this is relevant because CDC guidelines exclude that patient population.
  • The question arose about whether that 14 day rule should apply to bacterial superinfection of an initial viral pneumonia:
    • There is rationale for both doing and not doing this.
    • Before we make a final determination, Jen will perform a literature search about the frequency of such an event.
  • As the items contained in the "Recent Previous Pneumonia" segment of what is now on the VAP page (mainly the 14 day blackout rule) is relevant to all pneumonias, Tina will convert that to a template to be included in all the pneumonia Wiki pages
  • Jen will add some clarifying material to the 2nd primary bullet of the "Recent Previous Pneumonia" segment -- done

3. Should we categorize locations (dispo, previous locations, pre-admit) as general locations or as a specific location?

4. Add decubitus ulcer locations, request from SICU manager, Andie did a study evaluating the use of a new mepilex protective dressing. Her findings are as follows:

  • 6 months pre-trial n=27 with 12 non-coccyx ulcers
Total sacral/coccyx/buttock injuries- 15 
Stage 1	1
Stage 2	13
Stage 3	0
Stage 4	0
DTI	1

During/post 6 months (just missing November data at this time). n=13 with 10 or possible 7 non-coccyx ulcers 

Total sacral/coccyx/buttock injuries- 3 confirmed (however, 3 charts not reviewed yet…so could be up to 6)
Stage 1	 
Stage 2	 
Stage 3	1
Stage 4	 
DTI	1
Unstagable	1
    • Knowing the location long term will help us to track long term how we are doing without having to review every chart. While overall pressure injuries are good to know anecdotally, it doesn’t really give the big picture of if we are making an impact on the care. Especially since you are looking at the location anyways, does it hurt to record the area? Even a range of areas?
    • Our only tool currently to know locations etc is RL6 and we are quite certain that wounds are extremely underreported in RL.. I have not compared the data from the last year in RL vs these charts but I presume it will reflect this.
    • We also need to add DTI (deep tissue injury) as a new stage (ICD-10 dx)

5. Can we stop collecting past history of covid-19 infection (U07.5)? - Allan to email Bojan

6. Next meeting January 29 at 10 am CST

2024...

Also see Task Team Meeting - Rolling Agenda and Minutes 2024

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