2019-04-10 Anesthesia CRG Face-to-Face Meeting (London)

Andrew Norton

Introductions were made. Apologies for were received from Patrick McCormick Andrew Marchant user-d48df

The group noted with some concern that Andrew Marchant had been denied leave to attend the meeting and that the process of obtaining time to contribute to professional activity such as this was generally becoming more difficult. Additionally the group has noted difficulty in recruiting newer younger members and hoped that more engagement with governing professional bodies as evidence by the agenda of this meeting might help overcome this issue. Jane Millar and Charles Gutteridge are taking up issues of engagement with professional bodies

Andrew Marchant

Andrew Marchant

The group discussed the matter raised by Zac Whitewood-Moores regarding the anesthesia for xxxx codes. It was noted that they would create "noise" in an attempt to generate an anesthesia subset. To the group's knowledge it is the CPT codes themselves rather than the SNOMED equivalents that are used for billing and reimbursement in the USA. They would not conform to current SNOMED editorial guidelines. Agreed they should be retired from International release, possibly retained in US extension.

Andrew Norton

Monica Harry

James Palmer

Daniel Weegmann

Discussion started with consideration of para 2.3.1.3 of ACSA (Anaesthesia Clinical Standards Accreditation run by the Royal College of Anaesthetists). As currently drafted, these advocate the use of an electronic anaesthesia record in a fairly open way. Additional wording was suggested to mandate the use of record standards and controlled terminology which would be specified (HL7, open EHR, SNOMED CT) in the guidance notes. James Palmer will take these suggested revisions to ACSA for discussion and approval.

Daniel Weegmann gave a presentation on development work within the EPR at Salford Royal Hospitals Trust. This presentation focused on the move from free text entry to structured records based on health issues. Health issues have been gradually structured into Clinical terms (diagnoses, problems), Procedures and Risk factors. Entries since October 2018 are SNOMED encoded. Various methods of searching EPR records were demonstrated on a test data base.

A list of 18 significant anaesthesia issues (significant assessments or events that would have significant bearing on future procedures had been identified and implemented.

The group agreed that this work represented real progress in EPR functionality and utility. It was agreed that the team from Salford would be invited to present their anaesthesia records at the April 2020 meeting.

James Palmer raised some terminology issues:

1) At risk of difficult airway - existing number of finding terms. An at risk term would be included in terminology requests

2) Calder score (airway assessment - jaw protrusion) . Andrew Norton commented that for assessment scales to be included in SNOMED there needed to be a reasonable evidence base and a clear defintion - from internet search did not appear that these criteria were met but it would be further researched.

Post meeting note: There are SNOMED CT terms for reducued mandibular protrusion findings., original reference for Calder scale Anaesthesia 1992 47 582-9.

See prior discussion on Confluence:

• Head Trauma and use of the Glasgow Coma Score

"There are a number classification concepts currently within the terminology which are of the form: 

450569000 |Traumatic brain injury with loss of consciousness one hour or more (disorder)| 

in addition there seems to be an overlap between the use of the terminology to describe coma v loss of consciousness.  ..."

Some discussion took place in the morning with the Salford representatives present. James Palmer suggested that a definition of coma would be a GCS of 7 or below(suggesting need for airway support) + an AVPU (as part of NEWS scoring) of U. Discussion noted that the preferred way of doing this kind of assessment is Glasgow Coma Scoring and that GCS thresholds in definitions of coma and unconsciousness vary .

It was agreed that further input would be sought from Ed Cheetham (has already contributed in the discussion pages) and from the Academy of Medical Royal Colleges (via RCoA). Andrew Marchant is trying to get a contribution to the discussion from neurosurgeons in Edinburgh.

Afternoon session

Paul Amos noted the problems and overlap in defintions for coma and unconsciousness and there are a number of poor compound terms for brain injury many of which are ambiguous or imprecise. The QA initiative is hoping to remove ambiguous terms.

NICE (UK National Institute for Clinical Excellence) guidance on brain injury supports the use of Glasgow Coma Scoring with frequent remeasurement as indicated clinically

Monica Harry mentioned her new role as content manager and noted the quality assurance process taking place with regard to existing SNOMED CT content

Andrew Norton

Martin Hurrell

Martin Hurrell

Tuesday, May 28, 2019