Clinical Engagement

Page tree

Versions Compared

Old Version 23

changes.mady.by.user Andrew Norton

Saved on

compared with

New Version 24

changes.mady.by.user Patrick McCormick

Saved on

Key

  • This line was added.
  • This line was removed.
  • Formatting was changed.

Date

2017-04-23 to 2017-04-24

GoToMeeting Details

Anesthesia SIG
Sun, Apr 23, 2017 9:00 AM - 5:00 PM BST

https://global.gotomeeting.com/join/327260245

Anesthesia SIG Monday
Mon, Apr 24, 2017 1:30 PM - 5:30 PM BST

https://global.gotomeeting.com/join/503348413

You can also dial in using your phone.

United States: +1 (646) 749-3117

Access Code: 503-348-413

More phone numbers
Australia: +61 2 8355 1038
Austria: +43 1 2530 22500
Belgium: +32 28 93 7002
Canada: +1 (647) 497-9373
Denmark: +45 32 72 03 69
Germany: +49 69 5880 7802 72
Netherlands: +31 207 941 375
New Zealand: +64 9 913 2226
Spain: +34 912 71 8488
Sweden: +46 853 527 818
Switzerland: +41 225 4599 60
United Kingdom: +44 20 3713 5011

 

Attendees (Sunday)

Attendees (Monday)

Apologies

Sunday Morning Agenda

ItemDescriptionOwnerNotes
1WelcomePatrick McCormick

Introduction for James Palmer

2Approval of minutes from last meetingPatrick McCormickReviewed minutes
3Matters arising from the MinutesPatrick McCormick

 

Discussed history of outcome definitions and mapping
4

Introduction to Anesthesia SIG: history, objectives, current activity

Future as a VCG

Andrew Norton

Patrick McCormick

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

 < coffee break >  
5Awareness under Anesthesia

James Palmer

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)

 

 

 

6Adoption of SNOMED CT in Anesthesia

Andrew Norton

Following discussion under item 4, James Martin and Andrew Norton would seek to engage with Councils of the Royal College and Association of Anaesthetists to seek support for further adoption of SNOMED CT in UK Anaesthesia. Many US Anesthesia Information Management Systems currently installed or in implementation (eg EPIC) will support the use of SNOMED CT, but there is often a considerable amount of local configuration required
7Anesthesia machine / workstation failure

Andrew Norton

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.

 

Sunday Afternoon Agenda

ItemDescriptionOwnerNotes
1Welcome

Patrick McCormick

 

2

Anesthesia Quality Institute Outcome (AQI) terms

Review progress, discussion of new concepts

Patrick McCormick

Andrew Norton

Acute Kidney Injury:

    • Comorbidity concept "Acute Renal Impairment (disorder)" 236423003
    • Also see "Acute Non-traumatic Kidney Injury" and unreleased concept 726541005 (Acute Kidney Injury due to Trauma)
    • Has "acute kidney injury" been renamed to "acute renal failure"? PMID 18084974.
    • Monica Harry to look into who to contact re new renal terms in SNOMED (likely from European Renal Society work)
    • Andrew Norton to email Monica to confirm change above
    • Possible best match: Postoperative renal failure (disorder)
      • However, this concept doesn't have same parents as the above concepts, which should be fixed

Case Cancelled:

    • Three new concepts with definitions will be requested

Injury to Artery during Central Line Placement:

    • Will look into new concept specific to central lines and arteries. May have difficulty because we are generic for central line vessel and generic for injury vessel.

Are AQI definitions used outside US? Some in Canada, possibly in NZ.

 

New concept:

 

  • Infection associated with percutaneous neuraxial procedure
    • Superficial soft tissue infection associated with percutaneous neuraxial procedure
    • Epidural abscess associated with percutaneous neuraxial procedure
    • Meningitis associated with percutaneous neuraxial procedure
    • Sepsis associated with percutaneous neuraxial procedure

Infection associated with percutaneous peripheral nerve procedure

  • Superficial soft tissue infection associated with percutaneous peripheral nerve procedure
  • Deep tissue infection associated with percutaneous peripheral nerve procedure
  • Sepsis associated with percutaneous peripheral nerve procedure

    Procedure site indirect: peripheral nerve structure

Pathological process: superficial ST infection, deep T infection, sepsis
Associated Morphology: abscess, septicemia, ?
Associated process: peripheral nerve procedure

IV infiltration vs extravasation. (Local UK slang: "Tissued") Consider adding "intravenous infiltration" as a disorder.

Perioperative Visual Loss: Will look into new concept

Consider new concept: "Peripheral neurological deficit associated with percutaneous peripheral nerve procedure"

POCD

New concept "Postoperative cognitive dysfunction" - no longer be synonym of postoperative delirium

"Emergence delirium" should get new concept because it is transient, not the same as postoperative delirium

PDNV

Create new concept "Post-discharge nausea or vomiting" as child PONV

Includes inpatients and outpatients

 

Consider "Neuraxial hematoma associated with percutaneous neuraxial procedure"

Will look into new concept for unticipated transfusion

 

Unplanned conversion to general anesthesia

 

 

Monday Afternoon Agenda

ItemDescriptionOwnerNotes
1Welcome

Patrick McCormick

 

2Update on drug and substance remodellingToni Morrison

(Possibly during Modelling Advisory Group session

on Monday morning)

3Issues from recent terminology requests

Monica Harry

 
4

Hypothermia in anesthesia with ref. to planned /unplanned procedures

Monica Harry

Andrew Norton

Following issues raised at SIG meeting

28th March 2017

5Modelling of assessment scale components  
6VCG's and clinical engagementIan Green 
6Close

Patrick McCormick