2017-04-23 Anesthesia SIG Face to Face Meeting

Introduction for James Palmer

Introduction to Anesthesia SIG: history, objectives, current activity

Future as a VCG

DDTF page at APSF

IOTA page at APSF

AN gave a summary of the development of coding systems including development of Read, CTV3, SNOMED and SNOMED CT and the history of the Anesthesia SIG from the time of the DDTF (Data Dictionary Task Force) - see links above. Discussion agreed that SNOMED CT remains the best way to move forward with structured recording of anesthesia data, especially complications and morbidity in anesthesia, but a renewed effort is needed at least in the UK to engage with the Royal College and Association of Anaesthetists - possibly these bodies should nominate representatives to the Anesthesia SIG

RCOA National Audit Projects - UK-wide initiative to capture rates of awareness, airway management complications, and other issues

Future as a VCG. The group did not anticipate major changes in current ways of working but needs increased emphasis on seeking support of anesthesia related items on SNOMED International workplans. Current meeting schedule to continue. Issues to be raised and clarified at HPCG meeting on Tuesday 25th April

Outlined coding issue with awareness under anesthesia in ICD 10 (could only be added as a subcode of T85) arising from the NAP 5 audit project in the UK (awareness under anesthesia). Has reviewed existing SNOMED CT concepts and in discussion with UK terminology centre has considered possibilities of examining observable values for agent concentrations in patients in whom awareness is recorded.

Concepts to consider adding:

• Minimum alveolar concentration (MAC)
• End-tidal Minimum alveolar concentration (etMAC)
• Age-adjusted Minimum alveolar concentration (aaMAC)
• Age-adjusted End-tidal Minimum alveolar concentration (aaetMAC)

Synonyms of "Awareness under anesthesia" to remove (since they conflict with child term)

• GA - Depth of anaesthesia

• GA - Depth of anesthesia

Proposed child for "Awareness under general anesthesia":

• Accidental awareness under general anesthesia (AAGA)
  • Accidental awareness under general anesthesia during induction and/or intubation
  • Accidental awareness under general anesthesia during maintenance of anesthesia

Currently has "398204001 | Bispectral index (assessment scale) " - however this is a trademarked term.

• Depth of anesthesia (observable entity)

Retire:

• Light anesthesia (finding)

Need to add two terms:

• • Anesthesia machine failure
  • Anesthesia workstation failure
    It was noted that much of the world uses basic anesthesia machines (ie a gas and volatile agent delivery system) rather than the sophisticated integrated workstations prevalent in more developed nations.

ECG: anterior and posterior hemiblock - some issues with general structure of pattern findings. Hopefully classifier would model as ECG; presence findings. Screen shots from Protege model would be helpful.

Issues discussed around higher levels of nerve block anesthesia and classification. Direct substance is anaesthetic - in view of

•  "Absence of EKG finding" is child of "EKG finding", should be remodeled
  • Patrick suggested concept be done away with, but Bruce mentioned that some EMRs require postiive/negative response for each finding, and AndrewM noted that many people likely expect this concept to be present
• Local anesthesic procedure hierarchy restructuring
  • "Nerve block anesthesia" has child "Local anesthetic nerve block" - while this seems to be a synonym, problem is which substance is attached to concept, "local anesthetic" or "anesthetic"? The "anesthetic" substance includes general anesthetic agents as well as local anesthetics.
  • AndrewN: we attempted to rebuild nerve block hierarchy with CAP, not much progress made
• Patient positioning
  • mostly resolved, will email group with questions
• (Return of the) Gum elastic bougie
  • Denied request to make bougie synonym of introducer, will refer requestor back to Endotracheal tube introducers final.docx

New concepts modeled with new temporal attributes:

• Peri-operative complication
• Intraoperative complication

(Postoperative complication already existed)

Device Complications (presentation to follow)

Proposing that Complication Associated With Device hierarchy will go away, concepts to be moved to Complication of Device or elsewhere

Infection of central venous catheter (disorder) SCTID: 408866006 vs Central venous catheter associated bloodstream infection (disorder) SCTID: 473441009

Consider remodeling or offering new terms for common findings that occur in the postoperative or intraoperative.

Presentation on informal structure of VCG's moderated through pages on Confluence. Users would need to be logged on to participate in discussion, but the structure is informal with no chairs, formal agenda, regular meeting structure as it was felt that an enlarged formal "SIG" model is not sustainable for IHTSDO

Representation to IHTSDO would be through a clinical coordination froup but no specific membership from the VCG. However CCG would be responsible for championing a VCG project and securing the appropriate resources.

Members of the group raised concern about the lack of structure that could be detrimental to efforts to engage clinicians who would need some rationale to seek funding, allocate time and resource and justify participation (professionally and regulation - eg appraisal)