Syncope and Presyncope as a Presenting Symptom or Discharge Diagnosis in the Emergency Department: An Administrative Data Validation Study

2017 ◽  
Vol 33 (12) ◽  
pp. 1729-1732
Author(s):  
John A. Staples ◽  
Cristian Vadeanu ◽  
Bobby Gu ◽  
Shannon Erdelyi ◽  
Herbert Chan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Administrative Data ◽  
Validation Study ◽  
Discharge Diagnosis ◽  
Data Validation

scholarly journals A Computerized Method for Measuring Computed Tomography Pulmonary Angiography Yield in the Emergency Department: Validation Study (Preprint)

2018 ◽  
Author(s):  
Safiya Richardson ◽  
Philip Solomon ◽  
Alexander O'Connell ◽  
Sundas Khan ◽  
Jonathan Gong ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Validation Study ◽  
Chart Review ◽  
Pulmonary Angiography ◽  
Discharge Diagnosis ◽  
Appropriate Use ◽  
Computed Tomography Pulmonary Angiography ◽  
Computerized Method ◽  
Iatrogenic Harm

BACKGROUND Use of computed tomography pulmonary angiography (CTPA) in the assessment of pulmonary embolism (PE) has markedly increased over the past two decades. While this technology has improved the accuracy of radiological testing for PE, CTPA also carries the risk of substantial iatrogenic harm. Each CTPA carries a 14% risk of contrast-induced nephropathy and a lifetime malignancy risk that can be as high as 2.76%. The appropriate use of CTPA can be estimated by monitoring the CTPA yield, the percentage of tests positive for PE. This is the first study to propose and validate a computerized method for measuring the CTPA yield in the emergency department (ED). OBJECTIVE The objective of our study was to assess the validity of a novel computerized method of calculating the CTPA yield in the ED. METHODS The electronic health record databases at two tertiary care academic hospitals were queried for CTPA orders completed in the ED over 1-month periods. These visits were linked with an inpatient admission with a discharge diagnosis of PE based on the International Classification of Diseases codes. The computerized the CTPA yield was calculated as the number of CTPA orders with an associated inpatient discharge diagnosis of PE divided by the total number of orders for completed CTPA. This computerized method was then validated by 2 independent reviewers performing a manual chart review, which included reading the free-text radiology reports for each CTPA. RESULTS A total of 349 CTPA orders were completed during the 1-month periods at the two institutions. Of them, acute PE was diagnosed on CTPA in 28 studies, with a CTPA yield of 7.7%. The computerized method correctly identified 27 of 28 scans positive for PE. The one discordant scan was tied to a patient who was discharged directly from the ED and, as a result, never received an inpatient discharge diagnosis. CONCLUSIONS This is the first successful validation study of a computerized method for calculating the CTPA yield in the ED. This method for data extraction allows for an accurate determination of the CTPA yield and is more efficient than manual chart review. With this ability, health care systems can monitor the appropriate use of CTPA and the effect of interventions to reduce overuse and decrease preventable iatrogenic harm.

Missed acute myocardial infarction in the emergency department–standardizing measurement of misdiagnosis-related harms using the SPADE method

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Adam L. Sharp ◽  
Aileen Baecker ◽  
Najlla Nassery ◽  
Stacy Park ◽  
Ahmed Hassoon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adverse Event ◽  
Chest Pain ◽  
Administrative Data ◽  
Diagnostic Performance ◽  
Event Rate ◽  
Public Health Problem ◽  
Diagnostic Error ◽  
Adverse Event Rate ◽  
Disease Pair

AbstractObjectivesDiagnostic error is a serious public health problem. Measuring diagnostic performance remains elusive. We sought to measure misdiagnosis-related harms following missed acute myocardial infarctions (AMI) in the emergency department (ED) using the symptom-disease pair analysis of diagnostic error (SPADE) method.MethodsRetrospective administrative data analysis (2009–2017) from a single, integrated health system using International Classification of Diseases (ICD) coded discharge diagnoses. We looked back 30 days from AMI hospitalizations for antecedent ED treat-and-release visits to identify symptoms linked to probable missed AMI (observed > expected). We then looked forward from these ED discharge diagnoses to identify symptom-disease pair misdiagnosis-related harms (AMI hospitalizations within 30-days, representing diagnostic adverse events).ResultsA total of 44,473 AMI hospitalizations were associated with 2,874 treat-and-release ED visits in the prior 30 days. The top plausibly-related ED discharge diagnoses were “chest pain” and “dyspnea” with excess treat-and-release visit rates of 9.8% (95% CI 8.5–11.2%) and 3.4% (95% CI 2.7–4.2%), respectively. These represented 574 probable missed AMIs resulting in hospitalization (adverse event rate per AMI 1.3%, 95% CI 1.2–1.4%). Looking forward, 325,088 chest pain or dyspnea ED discharges were followed by 508 AMI hospitalizations (adverse event rate per symptom discharge 0.2%, 95% CI 0.1–0.2%).ConclusionsThe SPADE method precisely quantifies misdiagnosis-related harms from missed AMIs using administrative data. This approach could facilitate future assessment of diagnostic performance across health systems. These results correspond to ∼10,000 potentially-preventable harms annually in the US. However, relatively low error and adverse event rates may pose challenges to reducing harms for this ED symptom-disease pair.

scholarly journals Repeat emergency department visits by nursing home residents: a cohort study using health administrative data

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Andrea Gruneir ◽  
Candemir Cigsar ◽  
Xuesong Wang ◽  
Alice Newman ◽  
Susan E. Bronskill ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Nursing Home ◽  
Administrative Data ◽  
Nursing Home Residents ◽  
Emergency Department Visits ◽  
Health Administrative Data

Classification algorithms to improve the accuracy of identifying patients hospitalized with community-acquired pneumonia using administrative data

2010 ◽  
Vol 139 (9) ◽  
pp. 1296-1306 ◽  
Author(s):  
O. YU ◽  
J. C. NELSON ◽  
L. BOUNDS ◽  
L. A. JACKSON
Keyword(s):  
Administrative Data ◽  
Regression Tree ◽  
Epidemiological Studies ◽  
Community Acquired Pneumonia ◽  
Classification And Regression Tree ◽  
Classification Algorithms ◽  
Care Organization ◽  
Discharge Diagnosis ◽  
Diagnosis Code ◽  
Predictive Values

SUMMARYIn epidemiological studies of community-acquired pneumonia (CAP) that utilize administrative data, cases are typically defined by the presence of a pneumonia hospital discharge diagnosis code. However, not all such hospitalizations represent true CAP cases. We identified 3991 hospitalizations during 1997–2005 in a managed care organization, and validated them as CAP or not by reviewing medical records. To improve the accuracy of CAP identification, classification algorithms that incorporated additional administrative information associated with the hospitalization were developed using the classification and regression tree analysis. We found that a pneumonia code designated as the primary discharge diagnosis and duration of hospital stay improved the classification of CAP hospitalizations. Compared to the commonly used method that is based on the presence of a primary discharge diagnosis code of pneumonia alone, these algorithms had higher sensitivity (81–98%) and positive predictive values (82–84%) with only modest decreases in specificity (48–82%) and negative predictive values (75–90%).

Abstract TP369: EMS and ED Feedback Tool: Improving Metrics and Patient Outcome

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Angelia F Russell ◽  
Matthew E Tilem ◽  
Barbara V Voetsch
Keyword(s):  
Patient Outcome ◽  
Emergency Department ◽  
Stroke Patient ◽  
Stroke Care ◽  
Time Of Arrival ◽  
Modified Rankin Scale ◽  
Discharge Diagnosis ◽  
Cat Scan ◽  
Free Care ◽  
Patient’S Outcome

Background: Prompt recognition by emergency medical services (EMS) and emergency department (ED) triage is paramount in the treatment and survival of the stroke patient. We hypothesized that providing prompt feedback to EMS and ED on stroke care may improve EMS and hospital metrics and raise the hospital’s defect free care. Objective: To determine if the feedback provided to EMS and ED would improve the metrics and patient outcome. Method: A retrospective analysis comparing the percent of patients met the metrics prior to and after initiation of the feedback tools. Feedback forms were developed May 2015, education provided on forms Jun 2015, and implemented Jul 2015. Feedback was provided on all patients called in as a SA, BA on arrival, and/or patients with a discharge diagnosis of stroke. Results: Comparing the first six months prior to the feedback tool (127 BA in ED and 31 EMS SA) with the six months after (173 BA in the ED and 79 EMS SA) the Get with the Guideline (GWTG) timeline goals in the ED improved (Time of Arrival (TOA) to MD, goal 10 minutes, May 2015 35% to Dec 2015 100%; TOA to Neurology Consult, goal 15 minutes, May 2015 65% to Dec 2015 82%; TOA to Cat Scan (CT), goal 25 minutes, May 2015 41% to Dec 2015 79%; TOA to CT read, goal 45 minutes, May 2015 12% to Dec 2015 71%; TOA to t-PA, goal 60 minutes, May 2015 0% to Dec 2015 80%; CT ordered as a stroke, May 2015 21% to Dec 2015 84%; dysphagia screening prior to by mouth, May 2015 29% to Dec 93%) and the number of stroke alerts increased (pre-notification rates Q1/Q2 26.3%; Q3/Q4 56.8%). The hospital’s stroke defect free care in Q1/Q2 (77.3%) increased in Q1/Q2 2016 (97.2%). With the improvements in the EMS, ED, and hospital metrics, length of stay (LOS) decreased (Q1/Q2 5.77 days to Q3/Q4 5.05 days) and more patients were discharged with a lower modified Rankin Scale (mRS) (Q1/Q2 mRS 0-3 33%; Q3/Q4 mRS 0-3 48%). Conclusion: The EMS and ED metrics improved and continue to improve despite a growing and thriving neurology service. By providing the stroke care feedback, EMS and ED developed a more vested interested in the patient’s outcome. Based on the response from the EMS and ED staff on the stroke feedback tools, it is the most expedient and efficient way to communicate and continually educate on the care of the stroke patient both pre-hospital and in hospital.

Sign in / Sign up

Export Citation Format

Share Document