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Yoo HH, Ro YS, Ko E, Lee JH, Han SH, Kim T, Shin TG, Kim S, Chang H. Epidemiologic trends of patients who visited nationwide emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022. Clin Exp Emerg Med 2023; 10:S1-S12. [PMID: 37967858 PMCID: PMC10662522 DOI: 10.15441/ceem.23.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE : This study analyzed trends in emergency department (ED) visits in South Korea using the National Emergency Department Information System (NEDIS) data from 2018 to 2022. METHODS : This was a retrospective observational study using data from the NEDIS database from 2018 to 2022. Age- and sex-standardized ED visits per 100,000 population, as well as age- and sex-standardized rates for mortality, admission, and transfer, were calculated. RESULTS : The standardized ED visits per 100,000 population was approximately 20,000 from 2018 to 2019 and decreased to about 18,000 in 2022. The standardized mortality rate ranged from 1.4% to 1.7%. The admission rate (18.4%-19.4%) and the transfer rates (1.6%-1.8%) were similar during the study period. Approximately 5.5% of patients were triaged as Korean Triage and Acuity Scale score 1 or 2. About 91% of patients visited the ED directly and 21.7% of patients visited the ED with an ambulance. The ED length of stay was less than 6 hours in 90.3% of patients and the ED mortality rate was 0.6%. Acute gastroenteritis was the most common diagnosis. Respiratory virus symptoms, such as fever and sore throat, were also common chief complaints. CONCLUSION : ED visits decreased during the 5-year period, while admission, transfer, and death rates remained relatively stable.
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Affiliation(s)
- Hyun Ho Yoo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Sun Ro
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eunsil Ko
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Jin-Hee Lee
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - So-hyun Han
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seongjung Kim
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Chosun University Hospital, Gwangju, Korea
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Peta D, Day A, Lugari WS, Gorman V, Ahayalimudin N, Pajo VMT. Triage: A Global Perspective. J Emerg Nurs 2023; 49:814-825. [PMID: 37925222 DOI: 10.1016/j.jen.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/28/2023] [Accepted: 08/11/2023] [Indexed: 11/06/2023]
Abstract
Triage is a process by which patients are assessed, classified, and sorted based on their presenting complaint and clinical urgency, providing assurance for timely access to emergency care. The goal is to get the right person to the right place, in the right amount of time, for the right reason, and within the context of resource availability. In many countries, a standardized triage system, underpinned through the use of guidelines, is used to provide clinicians with support and guidance. Triage is a globally adopted principle, and although triage guidelines are used in many countries, no single system has been internationally adopted. This paper discusses the importance of how triage process standardization improves patient care, resource management, and benchmarking at local, national, and international levels by applying 5 internationally recognized triage systems to fictional case studies. Evaluation of similarities and differences in severity scores, with a gap analysis, occurs.
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3
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Lightbody T, Thull-Freedman J, Freedman SB, Wright B, Finseth N, Coulombe A, Morrissette M, DeGuerre A, McConnell S, Bozocea K, Groves-Johnston S, Woods J, Newton A. Use of quality improvement methods to enhance implementation of a mental health care bundle in a pediatric emergency department. CAN J EMERG MED 2023; 25:326-334. [PMID: 36964857 PMCID: PMC10039676 DOI: 10.1007/s43678-023-00476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/24/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVES We used quality improvement methods to implement a care bundle for children presenting to a pediatric emergency department (ED) with mental health concerns. A bundle novelty was that it included an option for assessment in a partnered clinic, not in the ED, to families of children assessed as having no medical or safety concerns. The primary aim of this study was to establish successful implementation of the bundle prior to studying its impact. METHODS The bundle included the Ask Suicide-Screening Questions to standardize risk assessment at triage, the HEADS-ED (Home, Education, Activities/Peers, Drug/Alcohol, Suicidality, Emotions/Behavior, Discharge Resources) tool for brief, scored mental health assessments, and offering an urgent appointment within 96 h for low-risk children as an alternative to ED-based assessment or as a follow-up option for patients assessed in the ED. We developed aims, driver diagrams, and outcome measures for each bundle element. Each element was introduced with small tests of change using iterative plan-do-study-act cycles. Run charts were used to determine successful completion of aims. RESULTS Rules for special cause were met through detection of shifts in performance 5 months after bundle implementation for the Ask Suicide-Screening Questions and HEADS-ED. These bundle elements were consistently used with ≥ 80% of eligible patients, representing aim achievement. During the 6 months of providing urgent appointments, 89.3% of 159 referred families received an appointment within 96 h. CONCLUSIONS Using quality improvement methods, we were able to successfully ensure reliable implementation of a new care bundle for pediatric patients presenting to the ED with mental health concerns and allow eligible low-risk patients to receive full assessments in a partnered clinic instead of the ED.
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Affiliation(s)
- Teresa Lightbody
- Children, Youth, and Families, Addiction and Mental Health-Edmonton Zone, Edmonton, AB, Canada.
- Northgate Health Centre, Alberta Health Services-Edmonton Zone, Edmonton, AB, Canada.
| | - Jennifer Thull-Freedman
- Division of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Stephen B Freedman
- Division of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Bruce Wright
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Faculty of Medicine and Dentistry, Stollery Children's Hospital University of Alberta, Women and Children's Research Institute, Edmonton, AB, Canada
| | - Nicole Finseth
- University of Alberta Hospital and Stollery Emergency Department, Edmonton, AB, Canada
| | - Angela Coulombe
- Children, Youth, and Families, Addiction and Mental Health-Edmonton Zone, Edmonton, AB, Canada
| | - Matthew Morrissette
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amanda DeGuerre
- Children, Youth, and Families, Addiction and Mental Health-Edmonton Zone, Edmonton, AB, Canada
| | - Stephanie McConnell
- Children, Youth, and Families, Addiction and Mental Health-Edmonton Zone, Edmonton, AB, Canada
| | - Karen Bozocea
- Children, Youth, and Families, Addiction and Mental Health-Edmonton Zone, Edmonton, AB, Canada
| | | | - Jennifer Woods
- University of Alberta Hospital and Stollery Emergency Department, Edmonton, AB, Canada
| | - Amanda Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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4
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Eysenbach G, Kleib M, Norris C, O'Rourke HM, Montgomery C, Douma M. The Use and Structure of Emergency Nurses' Triage Narrative Data: Scoping Review. JMIR Nurs 2023; 6:e41331. [PMID: 36637881 PMCID: PMC9883744 DOI: 10.2196/41331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Emergency departments use triage to ensure that patients with the highest level of acuity receive care quickly and safely. Triage is typically a nursing process that is documented as structured and unstructured (free text) data. Free-text triage narratives have been studied for specific conditions but never reviewed in a comprehensive manner. OBJECTIVE The objective of this paper was to identify and map the academic literature that examines triage narratives. The paper described the types of research conducted, identified gaps in the research, and determined where additional review may be warranted. METHODS We conducted a scoping review of unstructured triage narratives. We mapped the literature, described the use of triage narrative data, examined the information available on the form and structure of narratives, highlighted similarities among publications, and identified opportunities for future research. RESULTS We screened 18,074 studies published between 1990 and 2022 in CINAHL, MEDLINE, Embase, Cochrane, and ProQuest Central. We identified 0.53% (96/18,074) of studies that directly examined the use of triage nurses' narratives. More than 12 million visits were made to 2438 emergency departments included in the review. In total, 82% (79/96) of these studies were conducted in the United States (43/96, 45%), Australia (31/96, 32%), or Canada (5/96, 5%). Triage narratives were used for research and case identification, as input variables for predictive modeling, and for quality improvement. Overall, 31% (30/96) of the studies offered a description of the triage narrative, including a list of the keywords used (27/96, 28%) or more fulsome descriptions (such as word counts, character counts, abbreviation, etc; 7/96, 7%). We found limited use of reporting guidelines (8/96, 8%). CONCLUSIONS The breadth of the identified studies suggests that there is widespread routine collection and research use of triage narrative data. Despite the use of triage narratives as a source of data in studies, the narratives and nurses who generate them are poorly described in the literature, and data reporting is inconsistent. Additional research is needed to describe the structure of triage narratives, determine the best use of triage narratives, and improve the consistent use of triage-specific data reporting guidelines. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2021-055132.
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Affiliation(s)
| | - Manal Kleib
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | | | | | - Matthew Douma
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Feral-Pierssens AL, Morris J, Marquis M, Daoust R, Cournoyer A, Lessard J, Berthelot S, Messier A. Safety assessment of a redirection program using an electronic application for low-acuity patients visiting an emergency department. BMC Emerg Med 2022; 22:71. [PMID: 35488215 PMCID: PMC9052637 DOI: 10.1186/s12873-022-00626-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 04/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Emergency departments (EDs) are operating at or above capacity, which has negative consequences on patients in terms of quality of care and morbi-mortality. Redirection strategies for low-acuity ED patients to primary care practices are usually based on subjective eligibility criteria that sometimes necessitate formal medical assessment. Literature investigating the effect of those interventions is equivocal. The aim of the present study was to assess the safety of a redirection process using an electronic clinical support system used by the triage nurse without physician assessment. Methods A single cohort observational study was performed in the ED of a level 1 academic trauma center. All low-acuity patients redirected to nearby clinics through a clinical decision support system (February–August 2017) were included. This system uses different sets of medical prerequisites to identify patients eligible to redirection. Data on safety and patient experience were collected through phone questionnaires on day 2 and 10 after ED visit. The primary endpoint was the rate of redirected patients returning to any ED for an unexpected visit within 48 h. Secondary endpoints were the incidence of 7-day return visit and satisfaction rates. Results A total of 980 redirected low-acuity patients were included over the period: 18 patients (2.8%) returned unexpectedly to an ED within 48 h and 31 patients (4.8%) within 7 days. No hospital admission or death were reported within 7 days following the first ED visit. Among redirected patients, 81% were satisfied with care provided by the clinic staff. Conclusion The implementation of a specific electronic-guided decision support redirection protocol appeared to provide safe deferral to nearby clinics for redirected low-acuity patients. EDs are pivotal elements of the healthcare system pathway and redirection process could represent an interesting tool to improve the care to low-acuity patients.
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Affiliation(s)
- Anne-Laure Feral-Pierssens
- Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada. .,CR-CSIS, Sherbrooke University, Longueuil, Québec, Canada. .,Health Educations and Promotion Laboratory (LEPS EA3412), University Sorbonne Paris Nord, Bobigny, France. .,SAMU 93 - Emergency Department, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Bobigny, France.
| | - Judy Morris
- Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.,Département médecine de famille et médecine d'urgence, Université de Montréal, Montréal, Québec, Canada
| | - Martin Marquis
- Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada
| | - Raoul Daoust
- Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.,Département médecine de famille et médecine d'urgence, Université de Montréal, Montréal, Québec, Canada
| | - Alexis Cournoyer
- Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.,Département médecine de famille et médecine d'urgence, Université de Montréal, Montréal, Québec, Canada.,Hôpital Maisonneuve-Rosemont, CIUSSS-EIM, Montréal, Québec, Canada.,Corporation d'Urgences-santé, Montréal, Québec, Canada
| | - Justine Lessard
- Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.,Département médecine de famille et médecine d'urgence, Université de Montréal, Montréal, Québec, Canada
| | - Simon Berthelot
- Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, Canada.,Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Alexandre Messier
- Hôpital du Sacré-Cœur de Montréal, CIUSSS-NIM, 5400 boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.,Département médecine de famille et médecine d'urgence, Université de Montréal, Montréal, Québec, Canada
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6
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Picard CT, Kleib M, O'Rourke HM, Norris CM, Douma MJ. Emergency nurses' triage narrative data, their uses and structure: a scoping review protocol. BMJ Open 2022; 12:e055132. [PMID: 35418428 PMCID: PMC9014040 DOI: 10.1136/bmjopen-2021-055132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The first clinical interaction most patients have in the emergency department occurs during triage. An unstructured narrative is generated during triage and is the first source of in-hospital documentation. These narratives capture the patient's reported reason for the visit and the initial assessment and offer significantly more nuanced descriptions of the patient's complaints than fixed field data. Previous research demonstrated these data are useful for predicting important clinical outcomes. Previous reviews examined these narratives in combination or isolation with other free-text sources, but used restricted searches and are becoming outdated. Furthermore, there are no reviews focused solely on nurses' (the primary collectors of these data) narratives. METHODS AND ANALYSIS Using the Arksey and O'Malley scoping review framework and PRISMA-ScR reporting guidelines, we will perform structured searches of CINAHL, Ovid MEDLINE, ProQuest Central, Ovid Embase and Cochrane Library (via Wiley). Additionally, we will forward citation searches of all included studies. No geographical or study design exclusion criteria will be used. Studies examining disaster triage, published before 1990, and non-English language literature will be excluded. Data will be managed using online management tools; extracted data will be independently confirmed by a separate reviewer using prepiloted extraction forms. Cohen's kappa will be used to examine inter-rater agreement on pilot and final screening. Quantitative data will be expressed using measures of range and central tendency, counts, proportions and percentages, as appropriate. Qualitative data will be narrative summaries of the authors' primary findings. PATIENT AND PUBLIC INVOLVEMENT No patients involved. ETHICS AND DISSEMINATION No ethics approval is required. Findings will be submitted to peer-reviewed conferences and journals. Results will be disseminated using individual and institutional social media platforms.
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Affiliation(s)
- Christopher Thomas Picard
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Royal Alexandra Hospital, Emergency, Alberta Health Services, Edmonton, Alberta, Canada
| | - Manal Kleib
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Hannah M O'Rourke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew J Douma
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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7
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Kim SW, Kim YW, Min YH, Lee KJ, Choi HJ, Kim DW, Jo YH, Lee DK. Development and Validation of Simple Age-Adjusted Objectified Korean Triage and Acuity Scale for Adult Patients Visiting the Emergency Department. Yonsei Med J 2022; 63:272-281. [PMID: 35184430 PMCID: PMC8860940 DOI: 10.3349/ymj.2022.63.3.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The study aimed to develop an objectified Korean Triage and Acuity Scale (OTAS) that can objectively and quickly classify severity, as well as a simple age-adjusted OTAS (S-OTAS) that reflects age and evaluate its usefulness. MATERIALS AND METHODS A retrospective analysis was performed of all adult patients who had visited the emergency department at three teaching hospitals. Sex, systolic blood pressure, diastolic blood pressure, pulse rate, respiratory rate, body temperature, O2 saturation, and consciousness level were collected from medical records. The OTAS was developed with objective criterion and minimal OTAS level, and S-OTAS was developed by adding the age variable. For usefulness evaluation, the 30-day mortality, the rates of computed tomography scan and emergency procedures were compared between Korean Triage and Acuity Scale (KTAS) and OTAS. RESULTS A total of 44402 patients were analyzed. For 30-day mortality, S-OTAS showed a higher area under the curve (AUC) compared to KTAS (0.751 vs. 0.812 for KTAS and S-OTAS, respectively, p<0.001). Regarding the rates of emergency procedures, AUC was significantly higher in S-OTAS, compared to KTAS (0.807 vs. 0.830, for KTAS and S-OTAS, respectively, p=0.013). CONCLUSION S-OTAS showed comparative usefulness for adult patients visiting the emergency department as a triage tool compared to KTAS.
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Affiliation(s)
- Seung Wook Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong Won Kim
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Yong Hun Min
- Department of Emergency Medicine, Pohang St. Mary's Hospital, Pohang, Korea
| | - Kui Ja Lee
- Department of Emergency Medical Services, Kyungdong University, Wonju, Korea
| | - Hyo Ju Choi
- Department of Emergency Medical Services, Kyungdong University, Wonju, Korea
| | - Dong Won Kim
- Department of Emergency Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Keon Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
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8
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Goldman RD, Grafstein E, Barclay N, Irvine MA, Portales-Casamar E. Paediatric patients seen in 18 emergency departments during the COVID-19 pandemic. Emerg Med J 2020; 37:773-777. [PMID: 33127743 PMCID: PMC7604790 DOI: 10.1136/emermed-2020-210273] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Public health mitigation strategies in British Columbia during the pandemic included stay-at-home orders and closure of non-essential services. While most primary physicians' offices were closed, hospitals prepared for a pandemic surge and emergency departments (EDs) stayed open to provide care for urgent needs. We sought to determine whether ED paediatric presentations prior and during the COVID-19 pandemic changed and review acuity compared with seasonal adjusted prior year. METHODS We analysed records from 18 EDs in British Columbia, Canada, serving 60% of the population. We included children 0-16 years old and excluded those with no recorded acuity or discharge disposition and those left without being seen by a physician. We compared prepandemic (before the first COVID-19 case), early pandemic (after first COVID-19 case) and peak pandemic (during public health emergency) periods as well as a similar time from the previous year. RESULTS A reduction of 57% and 70% in overall visits was recorded in the children's hospital ED and the general hospitals EDs, respectively. Average daily visits declined significantly during the peak-pandemic period (167.44±40.72) compared with prepandemic period (543.53±58.8). Admission rates increased mainly due to the decrease in the rate of visits with lower acuity. Children with complaints of 'fever' and 'gastrointestinal' symptoms had both the largest overall volume and per cent reduction in visits between peak-pandemic and prior year (79% and 74%, respectively). CONCLUSION Paediatric emergency medicine attendances were reduced to one-third of normal numbers during the 2020 COVID-19 lockdown in British Columbia, Canada, with the reduction mainly seen in minor illnesses that do not usually require admission.
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MESH Headings
- Adolescent
- Betacoronavirus/pathogenicity
- British Columbia/epidemiology
- COVID-19
- Child
- Child, Preschool
- Coronavirus Infections/diagnosis
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Coronavirus Infections/transmission
- Emergencies/epidemiology
- Emergency Medicine/organization & administration
- Emergency Medicine/statistics & numerical data
- Emergency Service, Hospital/organization & administration
- Emergency Service, Hospital/statistics & numerical data
- Female
- Health Services Accessibility/organization & administration
- Health Services Accessibility/statistics & numerical data
- Hospitals, Pediatric/organization & administration
- Hospitals, Pediatric/statistics & numerical data
- Humans
- Infant
- Infant, Newborn
- Male
- Pandemics/prevention & control
- Patient Admission/statistics & numerical data
- Patient Discharge/statistics & numerical data
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/transmission
- SARS-CoV-2
- Triage/organization & administration
- Triage/statistics & numerical data
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Affiliation(s)
- Ran D Goldman
- The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Eric Grafstein
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Neil Barclay
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
- Fraser Health, Vancouver, British Columbia, Canada
| | - Michael A Irvine
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Elodie Portales-Casamar
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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9
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McLeod SL, Thompson C, Borgundvaag B, Thabane L, Ovens H, Scott S, Ahmed T, Grewal K, McCarron J, Filsinger B, Mittmann N, Worster A, Agoritsas T, Bullard M, Guyatt G. Consistency of triage scores by presenting complaint pre- and post-implementation of a real-time electronic triage decision support tool. J Am Coll Emerg Physicians Open 2020; 1:747-756. [PMID: 33145515 PMCID: PMC7593433 DOI: 10.1002/emp2.12062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 11/08/2022] Open
Abstract
Objective eCTAS is a real‐time electronic decision‐support tool designed to standardize the application of the Canadian Triage and Acuity Scale (CTAS). This study addresses the variability of CTAS score distributions across institutions pre‐ and post‐eCTAS implementation. Methods We used population‐based administrative data from 2016–2018 from all emergency departments (EDs) that had implemented eCTAS for 9 months. Following a 3‐month stabilization period, we compared 6 months post‐eCTAS data to the same 6 months the previous year (pre‐eCTAS). We included triage encounters of adult (≥17 years) patients who presented with 1 of 16 pre‐specified, high‐volume complaints. For each ED, consistency was calculated as the absolute difference in CTAS distribution compared to the average of all included EDs for each presenting complaint. Pre‐eCTAS and post‐eCTAS change scores were compared using a paired‐samples t‐test. We also assessed if eCTAS modifiers were associated with triage consistency. Results There were 363,214 (183,231 pre‐eCTAS, 179,983 post‐eCTAS) triage encounters included from 35 EDs. Triage scores were more consistent (P < 0.05) post‐eCTAS for 6 (37.5%) presenting complaints: chest pain (cardiac features), extremity weakness/symptoms of cerebrovascular accident, fever, shortness of breath, syncope, and hyperglycemia. Triage consistency was similar pre‐ and post‐eCTAS for altered level of consciousness, anxiety/situational crisis, confusion, depression/suicidal/deliberate self‐harm, general weakness, head injury, palpitations, seizure, substance misuse/intoxication, and vertigo. Use of eCTAS modifiers was associated with increased triage consistency. Conclusions eCTAS increased triage consistency across many, but not all, high‐volume presenting complaints. Modifier use was associated with increased triage consistency, particularly for non‐specific complaints such as fever and general weakness.
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Affiliation(s)
- Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System Toronto Ontario Canada.,Division of Emergency Medicine Department of Family and Community Medicine University of Toronto Toronto Ontario Canada.,Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada
| | - Cameron Thompson
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System Toronto Ontario Canada
| | - Bjug Borgundvaag
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System Toronto Ontario Canada.,Division of Emergency Medicine Department of Family and Community Medicine University of Toronto Toronto Ontario Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada
| | - Howard Ovens
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System Toronto Ontario Canada.,Division of Emergency Medicine Department of Family and Community Medicine University of Toronto Toronto Ontario Canada
| | - Steve Scott
- Ontario Health (Cancer Care Ontario) Ministry of Health Toronto Ontario Canada
| | - Tamer Ahmed
- Ontario Health (Cancer Care Ontario) Ministry of Health Toronto Ontario Canada
| | - Keerat Grewal
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health System Toronto Ontario Canada
| | - Joy McCarron
- Ontario Health (Cancer Care Ontario) Ministry of Health Toronto Ontario Canada
| | - Brooke Filsinger
- Ontario Health (Cancer Care Ontario) Ministry of Health Toronto Ontario Canada
| | - Nicole Mittmann
- Ontario Health (Cancer Care Ontario) Ministry of Health Toronto Ontario Canada.,Sunnybrook Research Institute Toronto Ontario Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada.,Division of Emergency Medicine Department of Medicine McMaster University Hamilton Ontario Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada.,Division of General Internal Medicine and Division of Clinical Epidemiology University Hospitals of Geneva Geneva Switzerland
| | - Michael Bullard
- Department of Emergency Medicine University of Alberta Edmonton Alberta Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada.,Department of Medicine McMaster University Hamilton Ontario Canada
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Drynda S, Schindler W, Slagman A, Pollmanns J, Horenkamp-Sonntag D, Schirrmeister W, Otto R, Bienzeisler J, Greiner F, Drösler S, Lefering R, Hitzek J, Möckel M, Röhrig R, Swart E, Walcher F. Evaluation of outcome relevance of quality indicators in the emergency department (ENQuIRE): study protocol for a prospective multicentre cohort study. BMJ Open 2020; 10:e038776. [PMID: 32948571 PMCID: PMC7500312 DOI: 10.1136/bmjopen-2020-038776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Quality of emergency department (ED) care affects patient outcomes substantially. Quality indicators (QIs) for ED care are a major challenge due to the heterogeneity of patient populations, health care structures and processes in Germany. Although a number of quality measures are already in use, there is a paucity of data on the importance of these QIs on medium-term and long-term outcomes. The evaluation of outcome relevance of quality indicators in the emergency department study (ENQuIRE) aims to identify and investigate the relevance of QIs in the ED on patient outcomes in a 12-month follow-up. METHODS AND ANALYSIS The study is a prospective non-interventional multicentre cohort study conducted in 15 EDs throughout Germany. Included are all patients in 2019, who were ≥18 years of age, insured at the Techniker Krankenkasse (statutory health insurance (SHI)) and gave their written informed consent to the study.The primary objective of the study is to assess the effect of selected quality measures on patient outcome. The data collected for this purpose comprise medical records from the ED treatment, discharge (claims) data from hospitalised patients, a patient questionnaire to be answered 6-8 weeks after emergency admission, and outcome measures in a 12-month follow-up obtained as claims data from the SHI.Descriptive and analytical statistics will be applied to provide summaries about the characteristics of QIs and associations between quality measures and patient outcomes. ETHICS AND DISSEMINATION Approval of the leading ethics committee at the Medical Faculty of the University of Magdeburg (reference number 163/18 from 19 November 2018) has been obtained and adapted by responsible local ethics committees.The findings of this work will be disseminated by publication of peer-reviewed manuscripts and presentations as conference contributions (abstracts, poster or oral presentations).Moreover, results will be discussed with clinical experts and medical associations before being proposed for implementation into the quality management of EDs. TRIAL REGISTRATION NUMBER German Clinical Trials Registry (DRKS00015203); Pre-results.
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Affiliation(s)
- Susanne Drynda
- Department of Trauma Surgery, Otto von Guericke University, Magdeburg, Germany
| | - Wencke Schindler
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University, Magdeburg, Germany
| | - Anna Slagman
- Emergency and Acute Medicine, Charité, Berlin, Germany
| | - Johannes Pollmanns
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
| | | | | | - Ronny Otto
- Department of Trauma Surgery, Otto von Guericke University, Magdeburg, Germany
| | - Jonas Bienzeisler
- Institute of Medical Informatics, RWTH Aachen University, Aachen, Germany
| | - Felix Greiner
- Department of Trauma Surgery, Otto von Guericke University, Magdeburg, Germany
| | - Saskia Drösler
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Köln, Germany
| | | | - Martin Möckel
- Emergency and Acute Medicine, Charité, Berlin, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, RWTH Aachen University, Aachen, Germany
| | - Enno Swart
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto von Guericke University, Magdeburg, Germany
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Decision aid for early identification of acute underlying illness in emergency department patients with atrial fibrillation or flutter. CAN J EMERG MED 2020; 22:301-308. [PMID: 31856926 DOI: 10.1017/cem.2019.454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Emergency department (ED) patients with atrial fibrillation or flutter (AFF) with underlying occult condition such as sepsis or heart failure, and who are managed with rate or rhythm control, have poor prognoses. Such conditions may not be easy to identify early in the ED evaluation when critical treatment decisions are made. We sought to develop a simple decision aid to quickly identify undifferentiated ED AFF patients who are at high risk of acute underlying illness. METHODS We collected consecutive ED patients with electrocardiogram-proven AFF over a 1-year period and performed a chart review to ascertain demographics, comorbidities, and investigations. The primary outcome was having an acute underlying illness according to prespecified criteria. We used logistic regression to identify factors associated with the primary outcome, and developed criteria to identify those with an underlying illness at presentation. RESULTS Of 1,083 consecutive undifferentiated ED AFF patients, 400 (36.9%) had an acute underlying illness; they were older with more comorbidities. Modeling demonstrated that three predictors (ambulance arrival; chief complaint of chest pain, dyspnea, or weakness; CHA2DS2-VASc score greater than 2) identified 93% of patients with acute underlying illness (95% confidence interval [CI], 91-96%) with 54% (95% CI, 50-58%) specificity. The decision aid missed 28 patients; (7.0%) simple blood tests and chest radiography identified all within an hour of presentation. CONCLUSIONS In ED patients with undifferentiated AFF, this simple predictive model rapidly differentiates patients at risk of acute underlying illness, who will likely merit investigations before AFF-specific therapy.
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Lucas B, Schladitz P, Schirrmeister W, Pliske G, Walcher F, Kulla M, Brammen D. The way from pen and paper to electronic documentation in a German emergency department. BMC Health Serv Res 2019; 19:558. [PMID: 31399096 PMCID: PMC6688333 DOI: 10.1186/s12913-019-4400-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 08/05/2019] [Indexed: 11/12/2022] Open
Abstract
Background Some of the advantages of implementing electronic emergency department information systems (EDIS) are improvements in data availability and simplification of statistical evaluations of emergency department (ED) treatments. However, for multi-center evaluations, standardized documentation is necessary. The AKTIN project (“National Emergency Department Register: Improvement of Health Services Research in Acute Medicine in Germany”) has used the “German Emergency Department Medical Record” (GEDMR) published by the German Interdisciplinary Association of Intensive and Emergency Care as the documentation standard for its national data registry. Methods Until March 2016 the documentation standard in ED was the pen-and-paper version of the GEDMR. In April 2016 we implemented the GEDMR in a timeline-based EDIS. Related to this, we compared the availability of structured treatment information of traumatological patients between pen-and-paper-based and electronic documentation, with special focus on the treatment time. Results All 796 data fields of the 6 modules (basic data, severe trauma, patient surveillance, anesthesia, council, neurology) were adapted for use with the existing EDIS configuration by a physician working regularly in the ED. Electronic implementation increased availability of structured anamnesis and treatment information. However, treatment time was increased in electronic documentation both immediately (2:12 ± 0:04 h; n = 2907) and 6 months after implementation (2:18 ± 0:03 h; n = 4778) compared to the pen-and-paper group (1:43 ± 0:02 h; n = 2523; p < 0.001). Conclusions We successfully implemented standardized documentation in an EDIS. The availability of structured treatment information was improved, but treatment time was also increased. Thus, further work is necessary to improve input time.
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Affiliation(s)
- Benjamin Lucas
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, D 39120, Magdeburg, Germany.
| | - Peter Schladitz
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, D 39120, Magdeburg, Germany
| | - Wiebke Schirrmeister
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, D 39120, Magdeburg, Germany
| | - Gerald Pliske
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, D 39120, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, D 39120, Magdeburg, Germany
| | - Martin Kulla
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Bundeswehrhospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - Dominik Brammen
- Department of Anaesthesiology and Intensive Care, Otto-von-Guericke University Magdeburg, D-39120, Magdeburg, Germany
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Lessons learned in applying the International Society for Pharmacoeconomics and Outcomes Research methodology to translating Canadian Emergency Department Information System Presenting Complaints List into German. Eur J Emerg Med 2018; 25:295-299. [PMID: 28145941 PMCID: PMC6039420 DOI: 10.1097/mej.0000000000000450] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The patient's presenting complaint guides diagnosis and treatment in the emergency department, but there is no classification system available in German. The Canadian Emergency Department Information System (CEDIS) Presenting Complaint List (PCL) is available only in English and French. As translation risks the altering of meaning, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) has set guidelines to ensure translational accuracy. The aim of this paper is to describe our experiences of using the ISPOR guidelines to translate the CEDIS PCL into German. MATERIALS AND METHODS The CEDIS PCL (version 3.0) was forward-translated and back-translated in accordance with the ISPOR guidelines using bilingual clinicians/translators and an occupationally mixed evaluation group that completed a self-developed questionnaire. RESULTS The CEDIS PCL was forward-translated (four emergency physicians) and back-translated (three mixed translators). Back-translation uncovered eight PCL items requiring amendment. In total, 156 comments were received from 32 evaluators, six of which resulted in amendments. CONCLUSION The ISPOR guidelines facilitated adaptation of a PCL into German, but the process required time, language skills and clinical knowledge. The current methodology may be applicable to translating the CEDIS PCL into other languages, with the aim of developing a harmonized, multilingual PCL.
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Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) Guidelines 2016. CAN J EMERG MED 2018; 19:S18-S27. [PMID: 28756800 DOI: 10.1017/cem.2017.365] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Inokuchi R, Maehara H, Iwai S, Iwagami M, Sato H, Yamaguchi Y, Asada T, Yamamoto M, Nakamura K, Hiruma T, Doi K, Morimura N. Interface design dividing physical findings into medical and trauma findings facilitates clinical document entry in the emergency department: A prospective observational study. Int J Med Inform 2018; 112:143-148. [PMID: 29500012 DOI: 10.1016/j.ijmedinf.2018.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/21/2018] [Accepted: 01/24/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The interface design and its effect on workflow are key determinants of the usability of electronic medical records (EMRs) in the emergency department (ED). However, whether the overall clinical care can be improved by dividing the interface design of physical findings into medical and trauma findings is unknown. We previously developed an EMR system in which the checkpoints were separated into different sections according to the body part. Herein, we modified this EMR system by remaking the interface design specifically for trauma patients, and evaluated its performance. METHODS This study was undertaken in a single-center ED between October 2014 and September 2015. In the modified EMR system, all trauma findings are displayed together on the screen, according to the Japan Advanced Trauma Evaluation and Care. We compared the time to final documentation entry and the length of ED stay between the previous (used in the first 6 months) and current systems (used in the latter 6 months). Furthermore, we stratified the patients by triage levels. RESULTS The study involved 2141 patients (934 and 1207 assessed using the previous and modified EMR systems, respectively). The modified EMR in trauma patients significantly decreased the time to final documentation entry from 131.5 [interquartile range, 86.8-207.3] to 115 [78.8-161] min (p = 0.049). When stratifying trauma patients by triage level, significantly shorter clinical documentation times were observed with the modified EMR system in levels 2 (emergency) and 3 (urgent). CONCLUSIONS Using different interfaces for trauma findings shortened the time for clinical documentation for trauma patients.
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Affiliation(s)
- Ryota Inokuchi
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Emergency and Critical Care Medicine, JR Tokyo General Hospital, Yoyogi, Shibuya-ku, Tokyo, Japan.
| | - Hiromu Maehara
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Emergency and Critical Care Medicine, JR Tokyo General Hospital, Yoyogi, Shibuya-ku, Tokyo, Japan
| | - Satoshi Iwai
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masao Iwagami
- London School of Hygiene and Tropical Medicine, Keppel St., Bloomsbury, London WC1E 7HT, United Kingdom
| | - Hajime Sato
- Department of Health Policy and Technology Assessment, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama 351-0197, Japan
| | - Yoko Yamaguchi
- Department of Emergency and Critical Care Medicine, JR Tokyo General Hospital, Yoyogi, Shibuya-ku, Tokyo, Japan
| | - Toshifumi Asada
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Miyuki Yamamoto
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kensuke Nakamura
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Takahiro Hiruma
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Naoto Morimura
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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[Standardized collection of presenting complaints in the emergency room : Integration of coded presenting complaints into the electronic medical record system of an emergency department and their value for health care research]. Med Klin Intensivmed Notfmed 2017; 113:115-123. [PMID: 28447144 DOI: 10.1007/s00063-017-0286-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/14/2017] [Accepted: 02/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The point of entry of a patient in emergency care is a symptom or a complaint. To evaluate subsequent processes in an emergency department until a diagnosis is made, this information has to be taken into account. OBJECTIVES We report the introduction of coded presenting complaints into the electronic medical record system of an emergency department and describe the patients based on these data. METHODS The CEDIS presenting complaint list was integrated into the emergency department information system of an emergency department (38,000 patients/year). After 8 months, we performed an exploratory analysis of the most common presenting complaints. Furthermore, we identified the most frequent diagnoses for presenting complaint "shortness of breath" and the most frequent presenting complaints for the diagnosis of sepsis. RESULTS After implementing the presenting complaint list, a presenting complaint code was assigned to each patient. In our sample (26,330 cases), "extremity pain and injury" comprised the largest group of patients (29.5%). "Chest pain-cardiac features" (3.7%) and "extremity weakness/symptoms of cerebrovascular accident" (2.4%) were the main cardiac and neurologic complaints, respectively. They were mostly triaged as urgent (>80%) and hospitalized in critical care units (>50%). The main diagnosis for presenting complaint "shortness of breath" was heart failure (25.1%), while the main presenting complaint for the diagnosis sepsis was "shortness of breath" (18.1%). CONCLUSIONS Containing 171 presenting complaints, this classification was implemented successfully without providing extensive staff training. The documentation of coded presenting complaints enables symptom-based analysis of the health care provided in emergency departments.
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Koyama T, Kashima T, Yamamoto M, Ouchi K, Kotoku T, Mizuno Y. A study of the effect of introduction of JTAS in the emergency room. Acute Med Surg 2017; 4:262-270. [PMID: 29123873 PMCID: PMC5674479 DOI: 10.1002/ams2.266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 01/04/2017] [Indexed: 11/09/2022] Open
Abstract
Aim The purpose of this study was to better understand the effects of introducing the Japan Triage and Acuity Scale (JTAS) in the emergency room for walk‐in patients. Methods A simple triage was used in Term A (from April 2006 to December 2010, 4 years and 9 months) and the JTAS was introduced in Term B (from January 2011 to September 2015, 4 years and 9 months). The number of patients who had a sudden turn for the worse after arrival in the emergency room and the time between attendance and emergency catheterization (TBAEC) due to acute coronary syndrome were reviewed. Results There were 653 patients in Term A and 626 patients in Term B who were finally diagnosed as having serious causes. There was no significant difference in the frequency of a sudden turn for the worse between the two terms. There were 182 patients in Term A and 167 patients in Term B who underwent emergency catheterization due to acute coronary syndrome. When ST elevation was recognized in the first electrocardiogram, the median time between attendance and medical attention during Term B improved significantly, by 4.5 min. However, there was no significant difference in medians for TBAEC. When ST elevation was not recognized, there was no significant difference between the two terms, neither in terms of median time between attendance and medical attention, nor TBAEC. Conclusion The data suggests that the effects of introducing the JTAS in the emergency room were restrictive in these two aspects.
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Affiliation(s)
- Toru Koyama
- Department of Emergency and Critical Care Medicine Aizawa Hospital Nagano Japan
| | - Takeshi Kashima
- Department of Emergency and Critical Care Medicine Aizawa Hospital Nagano Japan
| | - Motoyoshi Yamamoto
- Department of Emergency and Critical Care Medicine Aizawa Hospital Nagano Japan
| | - Kenjiro Ouchi
- Department of Emergency and Critical Care Medicine Aizawa Hospital Nagano Japan
| | - Takayuki Kotoku
- Department of Emergency and Critical Care Medicine Aizawa Hospital Nagano Japan
| | - Yuta Mizuno
- Department of Emergency and Critical Care Medicine Aizawa Hospital Nagano Japan
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Fernandes CMB, McLeod S, Krause J, Shah A, Jewell J, Smith B, Rollins L. Reliability of the Canadian Triage and Acuity Scale: interrater and intrarater agreement from a community and an academic emergency department. CAN J EMERG MED 2016; 15:227-32. [PMID: 23777994 DOI: 10.2310/8000.2013.130943] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The Canadian Triage and Acuity Scale (CTAS) is a five-level triage tool that is used to help prioritize the order in which emergency department (ED) patients should be seen. The objectives of this study were to determine the interrater and intrarater agreement of the 2008 CTAS guideline revisions by triage nurses and to compare agreement between triage nurses working in a small community ED and an academic ED. METHODS Seventy-eight triage nurses assigned CTAS scores and free-text presenting complaints for 10 paper-based case scenarios. For five scenarios, the CTAS score should have remained unchanged from previous guidelines, whereas the other five scenarios should have been triaged differently based on the 2008 CTAS first-order modifiers. Thirty-three participants repeated the questionnaire 90 days later, and intrarater agreement was measured. RESULTS There was a higher level of agreement (κ = 0.73; 95% CI 0.68-0.79) for the five case scenarios, which relied on the older 2004 guidelines compared to the scenarios where the 2008 guidelines would have suggested a different triage level (κ = 0.50; 95% CI 0.42-0.59). For the 10 case scenarios analyzed, the free-text presenting complaints matched the Canadian Emergency Department Information System (CEDIS) list 90.1% of the time (κ = 0.80; 95% CI 0.76-0.84). CONCLUSION The reliability of CTAS scoring by academic and community ED nurses was relatively good; however, the application of the 2008 CTAS revisions appears less reliable than the 2004 CTAS guidelines. These results may be useful to develop educational materials to strengthen reliability and validity for triage scoring using the 2008 CTAS guideline revisions.
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Scheuermeyer FX, Mackay M, Christenson J, Grafstein E, Pourvali R, Heslop C, MacPhee J, Ward J, Heilbron B, McGrath L, Humphries K. There Are Sex Differences in the Demographics and Risk Profiles of Emergency Department (ED) Patients With Atrial Fibrillation and Flutter, but no Apparent Differences in ED Management or Outcomes. Acad Emerg Med 2015; 22:1067-75. [PMID: 26291513 DOI: 10.1111/acem.12750] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 04/19/2015] [Accepted: 04/27/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In non-emergency department (ED) settings, women with atrial fibrillation and flutter (AFF) have different presentations, treatments, and outcomes than men: they are older, less likely to be treated with rhythm control strategies or appropriate anticoagulation, and more likely to have strokes. This has not been investigated in ED patients. METHODS Records from consecutive ED patients from January 1 to December 31, 2009, with electrocardiogram-proven AFF at two urban hospitals were collected. Review of administrative and clinical data identified patient demographics, clinical characteristics, comorbidities, and ED treatments. The regional ED database was queried to determine 30-day and 1-year follow-up visits, and the provincial vital statistics database was referenced to obtain 30-day and 1-year mortality; all outcomes were stratified by sex. The primary outcome, which reflected overall appropriateness of ED care, was the proportion of patients who were discharged home at their index ED visits, who then had unscheduled 30-day ED revisits. Secondary outcomes included the proportion of eligible patients who underwent acute rhythm control strategies and the proportion of high-risk patients who had previously inadequately anticoagulation strategies corrected by the emergency physician. Additional outcomes included the ED length of stay (LOS) and 30-day and 1-year rates of stroke and death. RESULTS A total of 1,112 records were reviewed: 470 women (42.3%) and 642 men. Women were a median 8 years (interquartile range = 3 to 13 years) older than men, had higher rates of cardiovascular comorbidities, and were more likely to present with atypical symptoms such as weakness or dyspnea. On their index ED visits, 50.2% of women and 41.3% of men were admitted. At 30 days, 39 of 234 (16.7%) women and 55 of 377 (14.6%) men who were discharged at their index ED visits had made revisits, for a risk difference of 2.1% (95% confidence interval = -3.9% to 8.5%). There were no apparent sex differences in the use of acute rhythm control or in the appropriateness of anticoagulation decisions. ED LOS was similar between women and men, as were 30-day and 1-year stroke or death rates. CONCLUSIONS Female ED AFF patients were older, had more comorbidities, and were more likely to be admitted. However, the overall management and outcomes, including 30-day revisits, appeared to be similar to that of males, indicating that there appeared to be little sex-based discrepancy in ED care and outcomes.
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Affiliation(s)
- Frank Xavier Scheuermeyer
- Department of Emergency Medicine; St. Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Martha Mackay
- Division of Cardiology; Department of Medicine; St. Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Jim Christenson
- Department of Emergency Medicine; St. Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Eric Grafstein
- Department of Emergency Medicine; Mount St. Joseph's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Reza Pourvali
- Department of Emergency Medicine; St. Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Claire Heslop
- Department of Emergency Medicine; St. Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Jan MacPhee
- Department of Emergency Medicine; St. Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - John Ward
- Department of Emergency Medicine; St. Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Brett Heilbron
- Division of Cardiology; Department of Medicine; St. Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Lorraine McGrath
- Division of Cardiology; Department of Medicine; St. Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Karin Humphries
- Division of Cardiology; Department of Medicine; St. Paul's Hospital and the University of British Columbia; Vancouver BC Canada
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Inokuchi R, Sato H, Iwagami M, Komaru Y, Iwai S, Gunshin M, Nakamura K, Shinohara K, Kitsuta Y, Nakajima S, Yahagi N. Impact of a New Medical Record System for Emergency Departments Designed to Accelerate Clinical Documentation: A Crossover Study. Medicine (Baltimore) 2015; 94:e856. [PMID: 26131837 PMCID: PMC4504572 DOI: 10.1097/md.0000000000000856] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Recording information in emergency departments (EDs) constitutes a major obstacle to efficient treatment. A new electronic medical records (EMR) system focusing on clinical documentation was developed to accelerate patient flow. The aim of this study was to examine the impact of a new EMR system on ED length of stay and physician satisfaction.We integrated a new EMR system at a hospital already using a standard system. A crossover design was adopted whereby residents were randomized into 2 groups. Group A used the existing EMR system first, followed by the newly developed system, for 2 weeks each. Group B followed the opposite sequence. The time required to provide overall medical care, length of stay in ED, and degree of physician satisfaction were compared between the 2 EMR systems.The study involved 6 residents and 526 patients (277 assessed using the standard system and 249 assessed with the new system). Mean time for clinical documentation decreased from 133.7 ± 5.1 minutes to 107.5 ± 5.4 minutes with the new EMR system (P < 0.001). The time for overall medical care was significantly reduced in all patient groups except triage level 5 (nonurgent). The new EMR system significantly reduced the length of stay in ED for triage level 2 (emergency) patients (145.4 ± 13.6 minutes vs 184.3 ± 13.6 minutes for standard system; P = 0.047). As for the degree of physician satisfaction, there was a high degree of satisfaction in terms of the physical findings support system and the ability to capture images and enter negative findings.The new EMR system shortened the time for overall medical care and was associated with a high degree of resident satisfaction.
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Affiliation(s)
- Ryota Inokuchi
- From the Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Bunkyo-ku (RI, YK, SI, MG, KN, YK, SN, NY); Department of General and Emergency Medicine, JR Tokyo General Hospital, Yoyogi, Shibuya-ku, Tokyo (RI, YK, SI); Department of Health Policy and Technology Assessment, National Institute of Public Health, Wako, Saitama, Japan (HS); London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK (MI); and Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, Koriyama, Fukushima, Japan (KS)
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Dong SL, Bullard MJ, Meurer DP, Blitz S, Holroyd BR, Rowe BH. The effect of training on nurse agreement using an electronic triage system. CAN J EMERG MED 2015; 9:260-6. [PMID: 17626690 DOI: 10.1017/s1481803500015141] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT
Objectives:
Emergency department (ED) triage prioritizes patients based on urgency of care, and the Canadian Triage and Acuity Scale (CTAS) is the national standard. We describe the inter-rater agreement and manual overrides of nurses using a CTAS-compliant web-based triage tool (eTRIAGE) for 2 different intensities of staff training.
Methods:
This prospective study was conducted in an urban tertiary care ED. In phase 1, eTRIAGE was deployed after a 3-hour training course for 24 triage nurses who were asked to share this knowledge during regular triage shifts with colleagues who had not received training (n = 77). In phase 2, a targeted group of 8 triage nurses underwent further training with eTRIAGE. In each phase, patients were assessed first by the duty triage nurse and then by a blinded independent study nurse, both using eTRIAGE. Inter-rater agreement was calculated using kappa (weighted κ) statistics.
Results:
In phase 1, 569 patients were enrolled with 513 (90.2%) complete records; 577 patients were enrolled in phase 2 with 555 (96.2%) complete records. Inter-rater agreement during phase 1 was moderate (weighted κ = 0.55; 95% confidence interval [CI] 0.49–0.62); agreement improved in phase 2 (weighted κ = 0.65; 95% CI 0.60–0.70). Manual overrides of eTRIAGE scores were infrequent (approximately 10%) during both periods.
Conclusions:
Agreement between study nurses and duty triage nurses, both using eTRIAGE, was moderate to good, with a trend toward improvement with additional training. Triage overrides were infrequent. Continued attempts to refine the triage process and training appear warranted.
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Affiliation(s)
- Sandy L Dong
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton
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Revisions to the Canadian Emergency Department Triage and Acuity Scale Implementation Guidelines. CAN J EMERG MED 2015. [DOI: 10.1017/s1481803500009428] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There has been widespread implementation of the Canadian Emergency Department Triage and Acuity Scale (CTAS) across Canada since it was introduced in 1999. This consensus document, developed by the CTAS National Working Group (NWG) of nurse and physician leaders in emergency department (ED) triage, continues to be viewed as a dynamic document that requires modification over time as experience is gained in its application. This article presents the first major modification to the CTAS.
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Affiliation(s)
- Eric Grafstein
- Department of Emergency Medicine, Providence Health Care, and St. Paul's Hospital, Vancouver, British Columbia, Canada.
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Abstract
ABSTRACTObjective:Managers of emergency departments (EDs), governments and researchers would benefit from reliable data sets that characterize use of EDs. Although Canadian ED lists for chief complaints and triage acuity exist, no such list exists for diagnosis classification. This study was aimed at developing a standardized Canadian Emergency Department Diagnosis Shortlist (CED-DxS), as a subset of the full International Classification of Diseases, 10th revision, with Canadian Enhancement (ICD-10-CA).Methods:Emergency physicians from across Canada participated in the revision of the ICD-10-CA through 2 rounds of the modified Delphi method. We randomly assigned chapters from the ICD-10-CA (approximately 3000 diagnoses) to reviewers, who rated the importance of including each diagnosis in the ED-specific diagnosis list. If 80% or more of the reviewers agreed on the importance of a diagnosis, it was retained for the final revision. The retained diagnoses were further aggregated and adjusted, thus creating the CED-DxS.Results:Of the 83 reviewers, 76% were emergency medicine (EM)–trained physicians with an average of 12 years of experience in EM, and 92% were affiliated with a university teaching hospital. The modified Delphi process and further adjustments resulted in the creation of the CED-DxS, containing 837 items. The chapter with the largest number of retained diagnoses was injury and poisoning (n= 292), followed by gastrointestinal (n= 59), musculoskeletal (n= 55) and infectious disease (n= 42). Chapters with the lowest number retained were neoplasm (n= 18) and pregnancy (n= 12).Conclusion:We report the creation of the uniform CED-DxS, tailored for Canadian EDs. The addition of ED diagnoses to existing standardized parameters for the ED will contribute to homogeneity of data across the country.
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Scheuermeyer FX, Pourvali R, Rowe BH, Grafstein E, Heslop C, MacPhee J, McGrath L, Ward J, Heilbron B, Christenson J. Emergency Department Patients With Atrial Fibrillation or Flutter and an Acute Underlying Medical Illness May Not Benefit From Attempts to Control Rate or Rhythm. Ann Emerg Med 2015; 65:511-522.e2. [DOI: 10.1016/j.annemergmed.2014.09.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/27/2014] [Accepted: 09/15/2014] [Indexed: 11/25/2022]
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Scheuermeyer FX, Innes G, Pourvali R, Dewitt C, Grafstein E, Heslop C, MacPhee J, Ward J, Heilbron B, McGrath L, Christenson J. Missed Opportunities for Appropriate Anticoagulation Among Emergency Department Patients With Uncomplicated Atrial Fibrillation or Flutter. Ann Emerg Med 2013; 62:557-565.e2. [DOI: 10.1016/j.annemergmed.2013.04.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/16/2013] [Accepted: 04/04/2013] [Indexed: 11/25/2022]
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Mowafi H, Dworkis D, Bisanzo M, Hansoti B, Seidenberg P, Obermeyer Z, Hauswald M, Reynolds TA. Making recording and analysis of chief complaint a priority for global emergency care research in low-income countries. Acad Emerg Med 2013; 20:1241-5. [PMID: 24283813 DOI: 10.1111/acem.12262] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/02/2013] [Accepted: 08/04/2013] [Indexed: 11/30/2022]
Abstract
The chief complaint is a patient's self-reported primary reason for presenting for medical care. The clinical utility and analytical importance of recording chief complaints have been widely accepted in highly developed emergency care systems, but this practice is far from universal in global emergency care, especially in limited-resource areas. It is precisely in these settings, however, that the use of chief complaints may have particular benefit. Chief complaints may be used to quantify, analyze, and plan for emergency care and provide valuable information on acute care needs where there are crucial data gaps. Globally, much work has been done to establish local practices around chief complaint collection and use, but no standards have been established and little work has been done to identify minimum effective sets of chief complaints that may be used in limited-resource settings. As part of the Academic Emergency Medicine consensus conference, "Global Health and Emergency Care: A Research Agenda," the breakout group on data management identified the lack of research on emergency chief complaints globally-especially in low-income countries where the highest proportion of the world's population resides-as a major gap in global emergency care research. This article reviews global research on emergency chief complaints in high-income countries with developed emergency care systems and sets forth an agenda for future research on chief complaints in limited-resource settings.
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Affiliation(s)
- Hani Mowafi
- The Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Daniel Dworkis
- The Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
| | - Mark Bisanzo
- The Department of Emergency Medicine; University of Massachusetts; Worcester MA
| | - Bhakti Hansoti
- The Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Phil Seidenberg
- The Department of Emergency Medicine; University of New Mexico; Albuquerque NM
- The Department of Emergency Medicine; Department of Medicine; University Teaching Hospital; Lusaka Zambia
| | - Ziad Obermeyer
- The Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
| | - Mark Hauswald
- The Department of Emergency Medicine; University of New Mexico; Albuquerque NM
| | - Teri A. Reynolds
- The Department of Emergency Medicine; University of California at San Francisco; San Francisco CA
- The Department of Emergency Medicine; Muhimbili Hospital; Dar Es Salaam Tanzania
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Pattern of use and presenting complaints of older patients visiting an Emergency Department in Italy. Aging Clin Exp Res 2013; 25:583-90. [PMID: 23949970 DOI: 10.1007/s40520-013-0112-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS The number of older persons admitted to the Emergency Department (ED) is dramatically increasing due to their complex medical and social problems, which in turn lead to longer clinical evaluation times and increased use of resources compared to younger adults. However, scant data are available for Italian EDs. Similarly, no data are available about the reasons to ED visit and its role in determining the ED utilization pattern. The study aimed at describing the pattern of ED use by older patients and main presenting complaints. METHODS Cross-sectional descriptive study of 5,826 ED patients in the city of Fano (Italy). Identifiers and triage, clinical and social data were collected. Presenting complaints as recorded by triage nurses have been recoded according to the Canadian Emergency Department Information System list version 1.1. Data were analyzed comparing older patients (more than 65 years-old) with younger adults (less than 65 years-old). RESULTS The prevalence of ED visits by older adults was 23.9 %. Their visits were characterized by higher emergency levels, admission rate and length of ED stay. Trauma was the main reason for ED presentation, especially among young adults, but elderly trauma patients were more frequently admitted because of hip fracture. Dyspnea and abdominal pain were the most frequent non-trauma presenting complaints among geriatric patients and represented the main causes for admission. CONCLUSIONS Older adults use the ED appropriately also in Italy. Trauma with complications (fracture) and various presenting complaints underlying medical problems accounted for more than 50 % of ED visits and hospital admissions.
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Scheuermeyer FX, Grafstein E, Stenstrom R, Christenson J, Heslop C, Heilbron B, McGrath L, Innes G. Safety and efficiency of calcium channel blockers versus beta-blockers for rate control in patients with atrial fibrillation and no acute underlying medical illness. Acad Emerg Med 2013; 20:222-30. [PMID: 23517253 DOI: 10.1111/acem.12091] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 09/25/2012] [Accepted: 10/01/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Many patients with atrial fibrillation (AF) are not candidates for rhythm control and may require rate control, typically with beta-blocking (BB) or calcium channel blocking (CCB) agents. Although these patients appear to have a low 30-day rate of stroke or death, it is unclear if one class of agent is safer or more effective. The objective was to determine whether BBs or CCBs would have a lower hospital admission rate and to measure 30-day safety outcomes including stroke, death, and emergency department (ED) revisits. METHODS This retrospective cohort study used a database from two urban EDs to identify consecutive patients with ED discharge diagnoses of AF from April 1, 2006, to March 31, 2010. Comorbidities, rhythms, management, and immediate outcomes were obtained by manual chart review, and patients with acute underlying medical conditions were excluded by predefined criteria. Patients managed only with rate control agents were eligible for review, and patients receiving BB agents were compared to those receiving CCB agents. The primary outcome was the proportion of patients requiring hospital admission; secondary outcomes included the ED length of stay (LOS), the proportion of patients having adverse events, the proportion of patients returning within 7 or 30 days, and the number of patients having a stroke or dying within 30 days. RESULTS A total of 259 consecutive patients were enrolled, with 100 receiving CCBs and 159 receiving BBs. Baseline demographics and comorbidities were similar. Twenty-seven percent of BB patients were admitted, and 31.0% of CCB patients were admitted (difference = 4.0%, 95% confidence interval [CI] = -7.7% to 16.1%), and there were no significant differences in ED LOS, adverse events, or 7- or 30-day ED revisits. One patient who received metoprolol had a stroke, and one patient who received diltiazem died within 30 days. CONCLUSIONS In this cohort of ED patients with AF and no acute underlying medical illness who underwent rate control only, patients receiving CCBs had similar hospital admission rates to those receiving BBs, while both classes of medications appeared equally safe at 30 days. Both CCBs and BBs are acceptable options for rate control.
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Affiliation(s)
- Frank Xavier Scheuermeyer
- Department of Emergency Medicine; St. Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Eric Grafstein
- Department of Emergency Medicine; Mount St Joseph's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Rob Stenstrom
- Department of Emergency Medicine; St. Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Jim Christenson
- Department of Emergency Medicine; St. Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Claire Heslop
- Department of Emergency Medicine; St. Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Brett Heilbron
- Division of Cardiology; St Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Lorraine McGrath
- Division of Cardiology; St Paul's Hospital and the University of British Columbia; Vancouver BC Canada
| | - Grant Innes
- Division of Emergency Medicine; Foothills Hospital and the University of Calgary; Calgary AB Canada
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Scheuermeyer FX, Grafstein E, Stenstrom R, Innes G, Heslop C, MacPhee J, Pourvali R, Heilbron B, McGrath L, Christenson J. Thirty-Day and 1-Year Outcomes of Emergency Department Patients With Atrial Fibrillation and No Acute Underlying Medical Cause. Ann Emerg Med 2012; 60:755-765.e2. [DOI: 10.1016/j.annemergmed.2012.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 05/02/2012] [Accepted: 05/08/2012] [Indexed: 10/28/2022]
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Development and validation of the excess mortality ratio-based Emergency Severity Index. Am J Emerg Med 2012; 30:1491-500. [PMID: 22381578 DOI: 10.1016/j.ajem.2011.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 11/01/2011] [Accepted: 12/09/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The purpose of this study is to develop and validate the excess mortality ratio-based Emergency Severity Index (EMR-ESI) that feasibly and objectively assesses the severity of emergency department (ED) patients based on their chief complaints. METHODS We used data from the National Emergency Department Information System of Korea from January 2006 to December 2009. We obtained information on mortality and the corresponding chief complaints exhibited by patients presenting to all EDs. The EMR-ESI was computed from the ratio of sex-age standardized hospital mortality for each chief complaint and the sex-age standardized mortality of the entire population of Korea. We tested the discriminatory power of the EMR-ESI on the prediction of hospital outcomes using the area under the receiver operating characteristic curve (AUC) from a multivariate logistic regression model. This model was adjusted for clinical parameters, and the goodness of fit was estimated using the Hosmer-Lemeshow logistic model. RESULTS Included in the study were 4 713 462 patients who presented 7557 chief complaint codes from 2006 to 2008. The EMR-ESI had a range of 0 to 6389.45 (mean ± SD, 1.11 ± 4.67; median, 0.70). The adjusted odds ratio of the EMR-ESI (unit, 1.0) for hospital mortality was 1.11 (95% confidence interval, 1.11-1.12). The AUCs for predicting hospital mortality, ED mortality, admission mortality, and admission were 0.95, 0.98, 0.90, and 0.74, respectively. There were 3 422 865 patients from 2009 who were included for external validation, and the AUCs for predicting mortality in the hospital, the ED, the inpatient ward, and for predicting admission were 0.95, 0.99, 0.90, and 0.75, respectively. CONCLUSION The EMR-ESI was notably useful in predicting hospital mortality and the admission of emergency patients.
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Lee JY, Oh SH, Peck EH, Lee JM, Park KN, Kim SH, Youn CS. The validity of the Canadian Triage and Acuity Scale in predicting resource utilization and the need for immediate life-saving interventions in elderly emergency department patients. Scand J Trauma Resusc Emerg Med 2011; 19:68. [PMID: 22050641 PMCID: PMC3223131 DOI: 10.1186/1757-7241-19-68] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/03/2011] [Indexed: 11/16/2022] Open
Abstract
Background We evaluated the validity of the Canadian Triage and Acuity Scale (CTAS) in elderly emergency department (ED) patients. In particular, we examined the sensitivity and specificity of the CTAS for identifying elderly patients who received an immediate life-saving intervention in the ED. Methods We reviewed the medical records of consecutive patients who were 65 years of age or older and presented to a single academic ED within a three-month period. The CTAS triage scores were compared to actual patient course, including disposition, discharge outcome and resource utilization. We calculated the sensitivity and specificity of the CTAS triage for identifying patients who received an immediate intervention. Results Of the 1903 consecutive patients who were ≥ 65 years of age, 113 (5.9%) had a CTAS level of 1, 174 (9.1%) had a CTAS level of 2, 1154 (60.6%) had a CTAS level of 3, 347 (18.2%) had a CTAS level of 4, and 115 (6.0%) had a CTAS level of 5. As a patient's triage score increased, the severity (such as mortality and intensive care unit admission) and resource utilization increased significantly. Ninety-four of the patients received a life-saving intervention within an hour following their arrival to the ED. The CTAS scores for these patients were 1, 2 and 3 for 46, 46 and 2 patients, respectively. The sensitivity and specificity of a CTAS score of ≤ 2 for identifying patients for receiving an immediate intervention were 97.9% and 89.2%, respectively. Conclusions The CTAS is a triage tool with high validity for elderly patients, and it is an especially useful tool for categorizing severity and for recognizing elderly patients who require immediate life-saving intervention.
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Affiliation(s)
- Ju Young Lee
- Emergency Team, Emergency Medical Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Scheuermeyer FX, Grafstein E, Heilbron B, Innes G. Emergency Department Management and 1-Year Outcomes of Patients With Atrial Flutter. Ann Emerg Med 2011; 57:564-571.e2. [DOI: 10.1016/j.annemergmed.2010.09.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 08/28/2010] [Accepted: 09/24/2010] [Indexed: 11/24/2022]
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Christ M, Grossmann F, Winter D, Bingisser R, Platz E. Modern triage in the emergency department. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:892-8. [PMID: 21246025 DOI: 10.3238/arztebl.2010.0892] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 02/10/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Because the volume of patient admissions to an emergency department (ED) cannot be precisely planned, the available resources may become overwhelmed at times ("crowding"), with resulting risks for patient safety. The aim of this study is to identify modern triage instruments and assess their validity and reliability. METHODS Review of selected literature retrieved by a search on the terms "emergency department" and "triage." RESULTS Emergency departments around the world use different triage systems to assess the severity of incoming patients' conditions and assign treatment priorities. Our study identified four such instruments: the Australasian Triage Scale (ATS), the Canadian Triage and Acuity Scale (CTAS), the Manchester Triage System (MTS), and the Emergency Severity Index (ESI). Triage instruments with 5 levels are superior to those with 3 levels in both validity and reliability (p<0.01). Good to very good reliability has been shown for the best-studied instruments, CTAS and ESI (κ-statistics: 0.7 to 0.95), while ATS and MTS have been found to be only moderately reliable (κ-statistics: 0.3 to 0.6). MTS and ESI are both available in German; of these two, only the ESI has been validated in German-speaking countries. CONCLUSION Five-level triage systems are valid and reliable methods for assessment of the severity of incoming patients' conditions by nursing staff in the emergency department. They should be used in German emergency departments to assign treatment priorities in a structured and dependable fashion.
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Affiliation(s)
- Michael Christ
- Interdisziplinäre Notaufnahmen, Klinikum Nürnberg, Germany.
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Ng CJ, Hsu KH, Kuan JT, Chiu TF, Chen WK, Lin HJ, Bullard MJ, Chen JC. Comparison Between Canadian Triage and Acuity Scale and Taiwan Triage System in Emergency Departments. J Formos Med Assoc 2010; 109:828-37. [DOI: 10.1016/s0929-6646(10)60128-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 10/28/2009] [Accepted: 12/30/2009] [Indexed: 10/18/2022] Open
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van der Wulp I, Sturms LM, Schrijvers AJP, van Stel HF. An observational study of patients triaged in category 5 of the Emergency Severity Index. Eur J Emerg Med 2010; 17:208-13. [PMID: 19820400 DOI: 10.1097/mej.0b013e32833154ba] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Patients triaged in category 5 of the Emergency Severity Index (ESI) do not need any resources before discharge from the emergency department (ED). We studied the characteristics of these patients and focused on those who were admitted or sent to the outpatient department after their ED visit. METHODS A retrospective observational study was conducted on 117 740 patient presentations. Patients were included in the study when they were triaged with the ESI and presented to one of the two EDs under study between 1 September 2004 and 1 June 2006. RESULTS Overall, 22.2% of the patients were triaged in ESI 5. Patients aged less than 40 years, women, and self-referred patients were most likely triaged in ESI 5, as well as patients presenting with complaints such as 'checkup appointments at the ED' and 'complaints of the skin'. Patients triaged in ESI 5 who were admitted or sent to the outpatient department were most likely elderly (aged above 65 years) and referred patients. They were also more likely to present with complaints such as 'postoperative complications, wound care problems, and plaster problems' and 'complaints of the genitourinary system'. CONCLUSION Although younger patients and women were more likely triaged in ESI 5, patients within this category who were admitted or sent to the outpatient department were more likely elderly and referred patients. Being admitted or sent to the outpatient department and triaged in ESI 5 indicates undertriage. Revision of the system is required to properly account for these patient groups.
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Affiliation(s)
- Ineke van der Wulp
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.
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Dix ans et toujours en train d’apprendre à marcher. CAN J EMERG MED 2009. [DOI: 10.1017/s1481803500011088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ten years old and still learning to walk. CAN J EMERG MED 2009; 11:127-30. [DOI: 10.1017/s1481803500011076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) adult guidelines. CAN J EMERG MED 2009; 10:136-51. [PMID: 18371252 DOI: 10.1017/s1481803500009854] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Revision of the Canadian Emergency Department Information System (CEDIS) Presenting Complaint List version 1.1. CAN J EMERG MED 2009; 10:151-73. [PMID: 18371253 DOI: 10.1017/s1481803500009878] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Révision des lignes directrices de l'Échelle canadienne de triage et de gravité (ÉTG) applicable aux enfants. CAN J EMERG MED 2008. [DOI: 10.1017/s1481803500010150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Haas SW, Travers D, Tintinalli JE, Pollock D, Waller A, Barthell E, Burt C, Chapman W, Coonan K, Kamens D, McClay J. Toward vocabulary control for chief complaint. Acad Emerg Med 2008; 15:476-82. [PMID: 18439204 DOI: 10.1111/j.1553-2712.2008.00104.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The chief complaint (CC) is the data element that documents the patient's reason for visiting the emergency department (ED). The need for a CC vocabulary has been acknowledged at national meetings and in multiple publications, but to our knowledge no groups have specifically focused on the requirements and development plans for a CC vocabulary. The national consensus meeting "Towards Vocabulary Control for Chief Complaint" was convened to identify the potential uses for ED CC and to develop the framework for CC vocabulary control. The 10-point consensus recommendations for action were 1) begin to develop a controlled vocabulary for CC, 2) obtain funding, 3) establish an infrastructure, 4) work with standards organizations, 5) address CC vocabulary characteristics for all user communities, 6) create a collection of CC for research, 7) identify the best candidate vocabulary for ED CCs, 8) conduct vocabulary validation studies, 9) establish beta test sites, and 10) plan publicity and marketing for the vocabulary.
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Affiliation(s)
- Stephanie W Haas
- School of Information and Library Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Révision de la liste de raisons de consultation du Système canadien d’information de gestion des départements d’urgence (SIGDU), version 1.1. CAN J EMERG MED 2008. [DOI: 10.1017/s148180350000988x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Révision des lignes directrices de l’Échelle canadienne de triage et de gravité (ÉTG) pour les adultes. CAN J EMERG MED 2008. [DOI: 10.1017/s1481803500009866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Lu HM, Zeng D, Trujillo L, Komatsu K, Chen H. Ontology-enhanced automatic chief complaint classification for syndromic surveillance. J Biomed Inform 2007; 41:340-56. [PMID: 17928273 DOI: 10.1016/j.jbi.2007.08.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 07/27/2007] [Accepted: 08/11/2007] [Indexed: 11/17/2022]
Abstract
Emergency department free-text chief complaints (CCs) are a major data source for syndromic surveillance. CCs need to be classified into syndromic categories for subsequent automatic analysis. However, the lack of a standard vocabulary and high-quality encodings of CCs hinder effective classification. This paper presents a new ontology-enhanced automatic CC classification approach. Exploiting semantic relations in a medical ontology, this approach is motivated to address the CC vocabulary variation problem in general and to meet the specific need for a classification approach capable of handling multiple sets of syndromic categories. We report an experimental study comparing our approach with two popular CC classification methods using a real-world dataset. This study indicates that our ontology-enhanced approach performs significantly better than the benchmark methods in terms of sensitivity, F measure, and F2 measure.
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Affiliation(s)
- Hsin-Min Lu
- Management Information Systems Department, The Eller College of Management, University of Arizona, 1130 E. Helen Street, Room 430, P.O. Box 210108, Tucson, AZ 85721-0108, USA.
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Rowe BH, Bond K, Ospina MB, Blitz S, Schull M, Sinclair D, Bullard M. Data collection on patients in emergency departments in Canada. CAN J EMERG MED 2007; 8:417-24. [PMID: 17209491 DOI: 10.1017/s1481803500014226] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Relatively little is known about the ability of Canadian emergency departments (EDs) and the federal, provincial and territorial governments to quantify ED activity. The objectives of this study were to determine the use of electronic patient data in Canadian EDs, the accessibility of provincial data on ED visits, and to identify the data elements and current methods of ED information system (EDIS) data collection nationally. METHODS Surveys were conducted of the following 3 groups: 1) all ED directors of Canadian hospitals located in communities of >10,000 people, 2) all electronic EDIS vendors, and 3) representatives from the ministries of health from 13 provincial and territorial jurisdictions who had knowledge of ED data collection. RESULTS Of the 243 ED directors contacted, 158 completed the survey (65% response rate) and 39% of those reported using an electronic EDIS. All 11 EDIS vendor representatives responded. Most of the vendors provide a similar package of basic EDIS options, with add-on features. All 13 provincial or territorial government representatives completed the survey. Nine (69%) provinces and territories collect ED data, however the source of this information varies. Five provinces and territories collect triage data, and 3 have a comprehensive, jurisdiction-wide, population-based ED database. Thirty-nine percent of EDs in larger Canadian communities track patients using electronic methods. A variety of EDIS vendor options are available and used in Canada. CONCLUSION The wide variation in methods and in data collected presents serious barriers to meaningful comparison of ED services across the country. It is little wonder that the majority of information regarding ED overcrowding in Canada is anecdotal, when the collection of this critical health information is so variable. There is an urgent need to place the collection of ED information on the provincial and national agenda and to ensure that the collection of this information consistent, comprehensive and mandatory.
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Affiliation(s)
- Brian H Rowe
- Department of Emergency Medicine, University of Alberta, 8440 112th Street, Edmonton, AB
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Thompson DA, Eitel D, Fernandes CMB, Pines JM, Amsterdam J, Davidson SJ. Coded Chief Complaints--automated analysis of free-text complaints. Acad Emerg Med 2006; 13:774-82. [PMID: 16723726 DOI: 10.1197/j.aem.2006.02.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To describe a new chief-complaint categorization schema, the development of a computer text-parsing algorithm to automatically classify free-text chief complaints into this schema, and use of these coded chief complaints to describe the case mix of a community emergency department (ED). METHODS Coded Chief Complaints for Emergency Department Systems (CCC-EDS) is a new and untested schema of 228 chief complaints, grouped within dimensions of type and system. A computerized text-parsing algorithm for automatically reading and classifying free-text chief complaints into 1 of these 228 coded chief complaints was developed by using a consecutive derivation sample of 46,602 patients who presented to a community teaching-hospital ED in 2004. Descriptive statistics included frequency of patients presenting with the 228 coded chief complaints; percentage of free-text complaints not categorizable by the CCC-EDS; and admission rate, age, and gender differences by chief complaint. RESULTS In the derivation sample, the text-parsing algorithm classified 87.5% of 45,329 ED visits with non-null free-text chief complaints into 1 of 194 coded chief complaints. The text-parsing algorithm successfully classified 87.3% of the free-text chief complaints in a validation sample. The five most common coded chief complaints were Abdominal Pain (3,734 visits), Fever (2,234), Chest Pain (2,183), Breathing Difficulty (2,030), and Cuts-Lacerations (2,028). CONCLUSIONS The CCC-EDS is a new comprehensive, granular, and useful classification schema for categorizing chief complaints in an ED. A CCC-EDS text-parsing algorithm successfully classified the majority of free-text chief complaints from an ED computer log. These coded chief complaints were used to describe the case mix of a community teaching-hospital ED.
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Affiliation(s)
- David A Thompson
- Department of Emergency Medicine, MacNeal Hospital, Berwyn, IL 60402, USA.
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