Triage, damned triage… and statistics: Sorting out redundancy and duplication within an Emergency Department Presenting Problem Code Set to enhance research capacity

Russell, Saartje Berendsen; Dinh, Michael; Bell, Nerida

doi:10.1016/j.aenj.2016.09.004

Cited by 12 publications

(5 citation statements)

References 15 publications

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“…To explore changing patterns of presentations of emergent ophthalmic presentations to the district's EDs and by extension the Westmead Eye Clinic during Australia's first wave of the COVID-19 pandemic, we retrospectively audited triage coding using the NSW Ministry of Health ED Presenting Problem Code Set (EDPPCS), a code set based on SNOMED CT terminology, 10,11 International Classification of Diseases, tenth revision, Australian modification (ICD-10-AM) final diagnosis coding, and separations data for ED presentations to the four hospitals within the Western Sydney Local Health District. Data from March 29 to May 31 in 2019 and 2020 (the COVID-19 lockdown period and corresponding period of the previous year), and from June 1 to July 31, 2019 and 2020 (the post-lockdown period and corresponding period of the previous year) was audited.…”

Section: Methodsmentioning

confidence: 99%

Reduction in Ophthalmic Presentations to Australian Emergency Departments During the COVID-19 Period: Are We Seeing the Full Picture?

Kam¹,

Gunasekaran²,

Chaudhry³

et al. 2021

OPTH

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Purpose To examine changing patterns of ophthalmic presentations to emergency departments (EDs) during the lockdowns associated with the first wave of the COVID-19 pandemic in Australia and the two months immediately following lockdown relaxation. Patients and Methods This was a retrospective audit of triage coding and ICD-10-AM coding for all patient presentations to four Australian EDs from March 29 to May 31 in 2019 and 2020 (the COVID-19 lockdown period and the corresponding period in 2019), and from June 1 to July 31 in 2019 and 2020 (the post-lockdown period and the corresponding period in 2019). Number of ophthalmic presentations triaged per day and number of seven common and/or time-sensitive, vision threatening ophthalmic diagnoses were examined. Differences in mean daily presentation numbers were assessed with non-paired Student’s t -test with Bonferroni correction. Results Total ophthalmic presentations per day during COVID-19 lockdowns fell by 16% compared to the corresponding period in 2019 (13.0 ± 4.0 in 2019 vs 10.8 ± 3.3 in 2020, mean ± standard deviation; p =0.01). There was also a significant decrease in presentations of atraumatic retinal detachment, conjunctivitis, and eye pain. In the two months following easing of lockdown restrictions, total ophthalmic presentations per day returned to the same level as that of the corresponding period in 2019 (12.2 ± 4.3 in 2019 vs 12.3 ± 4.1 in 2020, p =0.97). Conclusion Total ophthalmic presentations and presentations of atraumatic retinal detachment, conjunctivitis and, eye pain to EDs fell during the lockdowns associated with the first wave of COVID-19 in Australia. These may represent delays in patients seeking appropriate medical attention and may have implications on patient morbidity long after the COVID-19 pandemic.

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Section: Methodsmentioning

confidence: 99%

Reduction in Ophthalmic Presentations to Australian Emergency Departments During the COVID-19 Period: Are We Seeing the Full Picture?

Kam¹,

Gunasekaran²,

Chaudhry³

et al. 2021

OPTH

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“…The survey instrument was designed by the authors, and the separate components of the survey were developed in turn. Existing classification systems for health issues were reviewed [ 15 ], but a free-text response was selected to reduce respondent burden with respect to health literacy and response times, with the aim of categorizing responses for analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Free-text descriptions of the health issue were categorized into Berendsen Russell et al’s 17 presenting problem categories [ 15 ]. Descriptions with insufficient detail and categories with small numbers were merged into an “other” category, leaving nine categories for reporting (cardiovascular, gastrointestinal, infection, injury, mental health, musculoskeletal, neurology, respiratory, and other).…”

Section: Methodsmentioning

confidence: 99%

Access, Use, and Patient-Reported Experiences of Emergency Care During the COVID-19 Pandemic: Population-Based Survey

Gray¹,

Partington²,

Karnon³

2021

JMIR Hum Factors

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Background An increase in the number of people presenting to emergency departments (EDs) is contributing to ED overcrowding. In the early stages of the COVID-19 pandemic, there was a significant reduction in the number of ED presentations in Australia, creating an opportunity to learn from patients’ experiences of alternative management options. Objective The aim of this study is to report on the use and experience of health services by Australian adults experiencing a health issue during the COVID-19 pandemic for which they would have presented at an ED prior to the pandemic. Methods An online survey was conducted in May 2020. Reported health issues were categorized using an existing classification system. Data collected included demographics, care pathways, levels of concern at times of health issue and survey completion, and patient-reported experiences with care. Results A total of 1289 eligible respondents completed the survey. Almost 25% (309/1289) of respondents avoided an ED presentation, of which 58% (179/309) used an alternative form of health care and 42% (130/309) self-managed. Respondents making face-to-face or telehealth appointments with their general practitioner (GP) reported high levels of ED avoidance (135/286, 47%) and mostly positive experiences of care provided by GPs. A high proportion of those who self-managed reported high levels of concern at the time of completing the survey (42/130, 32%). Conclusions Telehealth consultations with GPs may be a more promotable alternative to the ED beyond the COVID-19 pandemic, providing easier access to a doctor with access to patients’ medical histories than an appointment for a face-to-face consultation. GP telehealth consultations may also address barriers to accessing health care for those with potentially the greatest need. The reported use and positive experiences with GP telehealth appointments should inform further research on their appropriateness as an alternative to the ED.

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“…Similar issues were identified in a previous NSW-based study. 33 Our research team will work with clinicians and relevant personnel to standardise the terminologies used to describe this data field prior to conducting the analyses. It is important to remember that the 3 SD above or below the population average to identify over-testing or under-testing using funnel plots does not necessarily imply the inappropriateness of test ordering.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Evaluating the long-term effects of a data-driven approach to reduce variation in emergency department pathology investigations: study protocol for evaluation of the NSW Health Pathology Atlas of variation

et al. 2020

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IntroductionVariation in test ordering is a major issue in Australia and globally with significant financial and clinical impacts. There is currently a lack of research identifying and remediating variation in the use of pathology tests in emergency departments (EDs). In 2019, NSW Health Pathology introduced the Pathology Atlas of Variation that uses a data-driven tool (the Atlas Analytical Model) to investigate test order variation across New South Wales (NSW) and engage with local health districts (LHDs) to reduce variation. The objectives of this study are to evaluate whether this data-driven approach is associated with: (1) a reduction in test order variation; (2) improvements in patient outcomes and (3) cost benefits, for the five most frequent ED presentations.Methods and analysisThis is a large multisite study including 45 major public hospitals across 15 LHDs in NSW, Australia. The Atlas Analytical Model is a data analytics and visualisation tool capable of providing analytical insights into variation in pathology investigations across NSW EDs, which will be used as feedback to inform LHDs efforts to reduce variation. Interrupted time series analyses using 2 years pre Atlas (2017–2018) and 2 years post Atlas (2021–2022) data will be conducted. Study data will be obtained by linking hospital and laboratory databases. Funnel plots will be used to identify EDs with outlying pathology test ordering practices. The outcome measures include changes in test ordering practices, ED length of stay, hospital admission and cost benefits (total pathology costs per ED encounter).Ethics and disseminationThe study has received ethical approval from the NSW Population and Health Service Research Ethics Committee (reference, 2019/ETH00184). The findings of the study will be published in peer-reviewed journals and disseminated via presentations at conferences. We will also engage directly with key stakeholders to disseminate the findings and to inform policies related to pathology testing in the ED.

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Triage, damned triage… and statistics: Sorting out redundancy and duplication within an Emergency Department Presenting Problem Code Set to enhance research capacity

Cited by 12 publications

References 15 publications

Reduction in Ophthalmic Presentations to Australian Emergency Departments During the COVID-19 Period: Are We Seeing the Full Picture?

Reduction in Ophthalmic Presentations to Australian Emergency Departments During the COVID-19 Period: Are We Seeing the Full Picture?

Access, Use, and Patient-Reported Experiences of Emergency Care During the COVID-19 Pandemic: Population-Based Survey

Evaluating the long-term effects of a data-driven approach to reduce variation in emergency department pathology investigations: study protocol for evaluation of the NSW Health Pathology Atlas of variation

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