In view of the current situation, this will be a short meeting to discuss current issues requiring feedback and comment if members have the capacity to do so

Present: Andrew Norton Andrew MarchantMonica Harry Patrick McCormick

Zac Whitewood-Moores Farzaneh Ashrafi Ian Green Ellen Torres Maria Hendrickson Jeremy Rogers Toni Morrison Martin Hurrell

Apologies: Steven Dain

Anesthesia Clinical Reference Group

Tue 7 Apr 2020 8pm – 9pm United Kingdom Time (1900-2000 UTC, 1500-1600 US EST)

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Meeting ID: 885 301 0974


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Introductions and ApologiesA moment's reflection recognised the difficulties across the world with COVID-19 infections.
Substance hierarchy proposed changes

See attachment Substance hierachy - Proposed Changes .docx

Draft changes suggested by Andrew Norton were generally agreed by the attendees, the draft will be circulated for further consideration.

It was felt that the FSN structure of "substance acting as a xxxx..." was potentially ambiguous and could create a misleading impression. The Anesthesia CRG was firmly of the opinion that the revised product hierarchy has to contain appropriate preferred terms for clinical usage and understanding

Any other business

SNOMED codes for COVID ICU 20200406.xlsx

Proposed content from 2020-04-07 Anesthesia CRG Meeting to support COVID-19 for the UK extension initially, but be grateful for feedback and additions.

High-Flow Oxygen terms are under review in SNOMED. A term exists for noninvasive ventilation, perhaps it will be useful to define subtypes of noninvasive ventilation. Increased sophistication of ICU ventilator modes allows for them often to be used either in an invasive (intubated patient) or noninvasive fashion (non-intubated pastient).

There was discussion of "Noninvasive ventilation without mechanical assist", and whether this equated to CPAP.

Further discussion centred on the topic of "Airway Swelling" and whether this was equivalent to one suggested term of "Subglottic Oedema". Clinically, the tests for airway swelling do not seem to be precisely specified - e.g. testing for leakage past an ETT prior to extubation in ICU patients. Andrew Nortonoffered to review the area for future discussions. 

There was agreement that further ad-hoc discussion might prove beneficial with regard to the fast-moving nature of COVID-19 and the use of terms to describe the phenomenon.

HL7 Domain Analysis Model for Intraoperative Anesthesia

Document for April 2020 HL7 ballot cycle. An overview of this draft was given by Martin and was considered comprehensive, further comments were welcomed and a draft copy will be available on the CRG pages for members.

Subsequent review by professional bodies such as the RCoA will be important.

SNOMED Terminology bindings : some example bindings have been included at the end of the document

Obtaining clinical domain expert review and comment: It was noted that this may be challenging given the current situation. The Ballot period is relatively short. Martin will attempt to clarify the position with HL7, but may have to defer consideration of some domain expert views until after ballot reconciliation.

Future Meetings
No scheduled meeting was planned in view of the COVID-19 situation. Further plans will be communicated.
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