Injury surveillance: a statewide survey of emergency department data collection practices

A consensus-based process to define standard national data elements for a Canadian emergency department information system

Canadian hospitals gather few emergency department (ED) data, and most cannot track their case mix, care processes, utilization or outcomes. A standard national ED data set would enhance clinical care, quality improvement and research at a local, regional and national level. The Canadian Association of Emergency Physicians, the National Emergency Nurses Affiliation and l'Association des médecins d'urgence du Québec established a joint working group whose objective was to develop a standard national ED data set that meets the information needs of Canadian EDs. The working group reviewed data elements derived from Australia's Victorian Emergency Minimum Dataset, the US Data Elements for Emergency Department Systems document, the Ontario Hospital Emergency Department Working Group data set and the Canadian Institute for Health Information's National Ambulatory Care Reporting System data set. By consensus, the group defined each element as mandatory, preferred or optional, and modified data definitions to increase their relevance to the ED context. The working group identified 69 mandatory elements, 5 preferred elements and 29 optional elements representing demographic, process, clinical and utilization measures. The Canadian Emergency Department Information System data set is a feasible, relevant ED data set developed by emergency physicians and nurses and tailored to the needs of Canadian EDs. If widely adopted, it represents an important step toward a national ED information system that will enable regional, provincial and national comparisons and enhance clinical care, quality improvement and research applications in both rural and urban settings.

The potential of using billing data for emergency department injury surveillance

OBJECTIVE

To determine the availability of and sample statewide ED injury information obtained from hospital billing data for the purpose of demonstrating the feasibility of information acquisition for subsequent data linkage.

METHODS

A retrospective, database investigation was conducted to obtain data describing a statewide stratified sample of ED patients. The aim was to collect a computerized billing summary record for each injured ED patient seen at each sampled hospital over a 1-year period. All 215 Pennsylvania acute care hospitals in 1991 were eligible for sample selection. Data collection for the project was conducted in 1993. Participants included directors of hospital medical records and billing departments.

RESULTS

Twenty-four hospitals contributed data sets from the original target goal of 31 strata. The final combined data set contained 187,404 records with injury diagnoses from approximately 616,000 ED patient visits, representing a 12% sample of all annual statewide ED visits. Age, sex, date of visit, and primary diagnosis fields were completed from the retrieved data > 99% of the time. More than two-thirds of the sampled records had a social security number, and total charges were recorded > 90% of the time. Other variables such as name and address were contained in < 50% of the records submitted. E-codes were usually not available.

CONCLUSIONS

Retrospective compilation of multihospital ED billing data to create a statewide ED data sample-with the potential for injury research and probabilistic database linkage-can be accomplished; there are, however, important limitations.