2017-04-23 to 2017-04-24
Sun, Apr 23, 2017 9:00 AM - 5:00 PM BST
Anesthesia SIG Monday
Mon, Apr 24, 2017 1:30 PM - 5:30 PM BST
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- Patrick McCormick
- Andrew Norton
- Andrew Marchant
- James Palmer
- Monica Harry
- Heather Sherman (AQI)
Sunday Morning Agenda
Introduction for James Palmer
|2||Approval of minutes from last meeting||Patrick McCormick||Reviewed minutes|
|3||Matters arising from the Minutes||Patrick McCormick|
|Discussed history of outcome definitions and mapping|
Introduction to Anesthesia SIG: history, objectives, current activity
Future as a VCG
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 >|
|5||Awareness under Anesthesia|
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:
Synonyms of "Awareness under anesthesia" to remove (since they conflict with child term)
Proposed child for "Awareness under general anesthesia":
Currently has "398204001 | Bispectral index (assessment scale) " - however this is a trademarked term.
|6||Adoption of SNOMED CT in Anesthesia||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|
|7||Anesthesia machine / workstation failure|
Need to add two terms:
Sunday Afternoon Agenda
Hypothermia in anesthesia with ref. to planned /unplanned procedures
Following issues raised at SIG meeting
28th March 2017
Anesthesia Quality Institute Outcome (AQI) terms
Review progress, discussion of new concepts
Acute Kidney Injury:
Injury to Artery during Central Line Placement Procedure: (bruce to test that)
Are AQI definitions used outside US? Some in Canada, possibly in NZ.
Infection following 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
Pathological process: superficial ST infection, deep T infection, sepsis
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"
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
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
|2||Issues from recent terminology requests|
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
|3||Update on drug and substance remodelling||Toni Morrison|
Presentation to follow
One problem: how to handle numeric values within SNOMED (e.g. how to code "60 mg"?) - Created new concepts in Number hierarchy; this will allow transformation to concrete domains.
|4||Modelling complications associated with devices||Bruce Goldberg|
New concepts modeled with new temporal attributes:
(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.
|5||VCG's and clinical engagement||Ian Green|
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)
|6||Modelling of assessment scales||Andrew Norton||Andrew Norton raised questions about modelling guidance for assessment scales and components. Monica and Toni noted that many scales are proprietary and would require expensive licensing. However there are a number of open source scales that would be useful to include and guidance on modelling would be helpful|