175 A Pilot Study of 360-Degree Perceptions of Emergency Physicians' Professionalism

Abstract

Methods: Six hundred clinical records of student visits to the ED in 6 academic years from 2009-10 to 2014-15 were randomly selected for chart review by 2 independent reviewers to identify visits with alcohol intoxication. Results were then compared with ICD-9 diagnostic codes indicating alcohol intoxication (30500, 30502, and 3030) in the hospital discharge database. Sensitivity, specificity, positive predictive and negative predictive values were calculated to evaluate the validity of diagnostic codes using the chart review as the "gold standard."Results: Over the study period, there were 9616 student visits to ED. Overall prevalence of alcohol intoxication was 10.4% based on ICD-9 diagnostic codes. Of the review sample of 600 records, the use of ICD-9 diagnostic codes in patient medical records identified 64 visits (10.6%) with alcohol intoxication, while the chart review identified 96 visits (16%) with alcohol intoxication. Sensitivity was 65%, indicating that ICD-9 diagnostic codes only captured 65% of the total ED visits with alcohol intoxication in the review sample. The specificity, positive predictive value, negative predictive value, and accuracy were 99%, 94%, 94%, and 94%, respectively (Table 1). There were 41 visits which involved both alcohol intoxication and injury or trauma, of which alcohol intoxication diagnostic codes were provided in only 18 visits (44%).Conclusions: Although code-based recording of student ED visits due to alcohol intoxication had a high level of accuracy, over one third of ED visits due to alcohol intoxication were not captured by diagnostic codes. In particular, when the visit also involved injury or trauma, only less than half of visits with alcohol intoxication were given a diagnostic code for this condition. Code-based measurement appears to severely underestimate the true burden of alcohol intoxication in the ED associated with student visits. There is a strong need to improve emergency physician coding of alcohol intoxication so that ED electronic medical records can serve as a reliable data source to evaluate the burden of alcohol intoxication in the hospital emergency setting.