2024-05-28 Anesthesia CRG Meeting

1

Introductions and Apologies

@Andrew Marchant 

2

Matters arising from the previous meeting notes

2024-04-16 Anesthesia CRG Face to Face Meeting

@Andrew Marchant 

3

SNOMED Update

@Charles Gutteridge 

4

Discussion Forum - induction of GA terms

@Patrick McCormick 

Induction of General Anesthesia

• discussed issues; will support a request to push the six inhalational anesthesia concepts under 241692007 |Inhalational induction (procedure)|

Anesthetic agents

• General anesthetic (substance)

• No "inhaled anesthetic" grouper

• There is a "General intravenous anesthetic (substance)"

• Per Monica, we do not want to add substance groupers as SNOMED is actively working on some substance initiatives

• Group is open to improvements in the inhaled anesthesia procedure concepts

4

Term discussion

405493003 | Inadequate equipment assessment (finding)

@Steven Dain writes
"

I am unclear on how to use this term. Note that it is a child of  127325009 | Procedure related finding (finding) |

The term "Inadequate equipment assessment" in my opinion is a procedure not a finding especially to be consistent with

226004006 | Medical equipment assessment (procedure) | which is a child of Evaluation Procedure (what is medical equipment?)  should there be a synonym of this Procedure Equipment assessment?

There is also 385874005 | Equipment safety assessment (procedure) | which is a child of 385869002 | Safety precautions assessment (procedure) |

Does it mean that one did an Equipment Adequacy check and found that the equipment is inadequate?  If so, we need a term "Adequate equipment assessment" (finding)

I would suggest

1. we deprecate the term 405493003 | Inadequate equipment assessment (finding) | or change to "Inadequate equipment (finding)"

2. add the synonym  Procedure Equipment assessment to  226004006 | Medical equipment assessment (procedure) | 

3. create new finding "Equipment inadequate" not sure the appropriate parent

4. create new finding "Equipment adequate"  not sure the appropriate parent

Thoughts?"

@Andrew Marchant 

"The term "Inadequate equipment assessment" isn't very clear:
- It could be an "assessment that equipment is inadequate", where the inadequacy of the equipment is the finding. That would make it a finding and be consistent with the context and description. It might be used, for example, when an item is removed from a surgical tray and found to be broken or contaminated (I recognise this scenario...). I wonder whether this is most likely.
- It could be a finding that "assessment of the equipment had been inadequate", where the inadequacy of the assessment is the finding. For example when a procedure is commenced in the belief that all equipment is appropriate but that is later found to not be the case.
- If it's a procedure, it could be an "inadequate assessment of equipment" or "an assessment of inadequate equipment". Then any refinements might have to explain in what way the staff/ procedures or the equipment are inadequate.
- equipment may be considered inadequate for many reasons (wrong spec for the case, out of date, superseded, not meeting manufactured spec, broken/ damaged/ dirty, failing to match operator training or preference). There would need to be some link as to why the equipment was found to be inadequate for this term to be useful.

"Medical Equipment" will be difficult to define. I co-chair our Medical Devices Committee and we are now looking at "devices" which were previously marketed as drugs (e.g. medicated ointments where the medication and preparation/ formulation are both relevant) as well as the physical/ software/ hybrid "devices" that we have been working with.

I think some of these terms need to be clarified which might risk making them wordier and might challenge style guidelines. Without approriate usage of words such as "of", "for" and "that" it can be quite difficult to be fully clear about meaning.

Another thought is that Assessments are usually made against some yardstick, often defined by the intended purpose (e.g. assessment of safe stair climbing ability with a view towards living independently in a specific place). Often this purpose is implicit, but perhaps it will sometimes need to be made explicit. Thus an anaesthetic machine which is assessed as electrically safe may be plugged in to the mains but that is only one step in seeing that it is ready for clinical use. Perhaps we should "assess equipment for clinical use (procedure)" and find it "adequate for clinical use (finding)" or "inadequate for clinical use (finding)"?

"

5

FHIR IG for Epidural Placement

@Grant Forrest 

Concept for the Identification of a Target Structure and Device Placement

Added comments to discussion

6

Dates of next meeting

 @Andrew Marchant 

Next meeting Tuesday July 23, 2024