scholarly journals Using deterministic record linkage to link ambulance and emergency department data: is it possible without patient identifiers?

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Sophie Jane Clark ◽  
Mary Halter ◽  
Alison Porter ◽  
Holly Christina Smith ◽  
Martin Brand ◽  
...  
Keyword(s):  
Emergency Department ◽  
Record Linkage ◽  
Emergency Departments ◽  
Data Linkage ◽  
Care Delivery ◽  
Ambulance Service ◽  
Emergency Department Data ◽  
Match Rate ◽  
Emergency Ambulance ◽  
The Uk

IntroductionRoutine linkage of emergency ambulance records with those from the emergency department is uncommon in the UK. Our study, known as the Pre-Hospital Emergency Department Data Linking Project (PHED Data), aimed to link records of all patients conveyed by a single emergency ambulance service to thirteen emergency departments in the UK from 2012-2016. Objectives We aimed to examine the feasibility and resource requirements of collecting de-identified emergency department patient record data and, using a deterministic matching algorithm, linking it to ambulance service data. Methods We used a learning log to record contacts and activities undertaken by the research team to achieve data linkage. We also conducted semi-structured interviews with information management/governance staff involved in the process. Results We found that five steps were required for successful data linkage for each hospital trust. The total time taken to achieve linkage was a mean of 65 weeks. A total of 958,057 emergency department records were obtained and, of these, 81% were linked to a corresponding ambulance record. The match rate varied between hospital trusts (50%-94%). Staff expressed strong enthusiasm for data linkage. Barriers to successful linkage were mainly due to inconsistencies between and within acute trusts in the recording of two ambulance event identifiers (CAD and call sign). Further data cleaning was required on emergency department fields before full analysis could be conducted. Ensuring the data was not re-identifiable limited validation of the matching method. Conclusion We conclude that deterministic record linkage based on the combination of two event identifiers (CAD and call sign) is possible. There is an appetite for data linkage in healthcare organisations but it is a slow process. Developments in standardising the recording of emergency department data are likely to improve the quality of the resultant linked dataset. This would further increase its value for providing evidence to support improvements in health care delivery. Highlights Ambulance records are rarely linked to other datasets; this study looks at the feasibility and resource requirement to use deterministic matching to link ambulance and emergency department data for patients conveyed by ambulance to the emergency department. It is possible to link these data, with an average match rate of 81% across 13 emergency departments and one large ambulance trust. All trusts approached provided match-able data and there was an appetite for data linkage; however, it was a long process taking an average of 65 weeks. We conclude that deterministic matching using no patient identifiers can be used in this setting.

scholarly journals Outcomes for Patients Who Contact the Emergency Ambulance Service and Are Not Transported to the Emergency Department: A Data Linkage Study

2019 ◽  
Vol 23 (4) ◽  
pp. 566-577 ◽  
Author(s):  
Joanne Coster ◽  
Alicia O'Cathain ◽  
Richard Jacques ◽  
Annabel Crum ◽  
A. Niroshan Siriwardena ◽  
...  
Keyword(s):  
Emergency Department ◽  
Data Linkage ◽  
Linkage Study ◽  
Ambulance Service ◽  
Emergency Ambulance

OP5 Closing emergency departments in england (CLOSED): the impact on ambulance services

2019 ◽  
Vol 36 (10) ◽  
pp. e4.1-e4
Author(s):  
Emma Knowles ◽  
Neil Shephard ◽  
Tony Stone ◽  
Lindsey Bishop-Edwards ◽  
Enid Hirst ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Control Area ◽  
Ambulance Service ◽  
Urgent Care ◽  
Computer Assisted ◽  
Care Providers ◽  
Interrupted Time Series Analysis ◽  
Additional Increase ◽  
Emergency Ambulance ◽  
The Impact

BackgroundIn recent years a number of Emergency Departments (EDs) in England have closed, or been replaced by a lower acuity facility such as an Urgent Care Centre. With further re-organisation of EDs expected, the ‘closED’ study aimed to provide research evidence to inform the public, NHS, and policymakers when considering future closures. Our aim was to understand the impact of ED closure on populations and emergency care providers, the first study to do so in England. In this session I will focus on the impact on the ambulance service.MethodsWe undertook a controlled interrupted time series analysis assessing changes in ambulance service activity, following the closure of Type 1 EDs in England. Data was sourced data from Ambulance service computer-assisted dispatch (CAD) records. The resident catchment populations of five EDs, closed between 2009 and 2011, were selected for analysis. Five control areas were also selected. The primary ambulance outcome measures were: ambulance service incident volumes and mean ‘call to destination’ time.ResultsThere was some evidence of a large increase of 13.9% [95% confidence interval (CI) 3.5% to 24.4%] in the total number of emergency ambulance incidents compared with the control areas. There was an increase of 3.9 minutes (95% CI 2.2 to 5.6 minutes) in the meantime taken from a 999 ‘red’ call being answered to a patient arriving at hospital.ConclusionsGiven such major reorganisation of emergency and urgent care we might expect some changes in emergency and urgency care activity. Our study found some changes in the ambulance service measures. The increase in emergency ambulance incidents, over and above the increase in the control area, suggests that the closure of the EDs in our study may have contributed to an additional increase in workload within the ambulance services in these areas.

scholarly journals General practitioners and emergency departments (GPED)—efficient models of care: a mixed-methods study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e024012
Author(s):  
Katherine Morton ◽  
Sarah Voss ◽  
Joy Adamson ◽  
Helen Baxter ◽  
Karen Bloor ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Studies ◽  
General Practitioners ◽  
Emergency Departments ◽  
Quantitative Methods ◽  
Public Involvement ◽  
Clinical Care ◽  
Urgent Care ◽  
The Uk ◽  
The Impact

IntroductionPressure continues to grow on emergency departments in the UK and throughout the world, with declining performance and adverse effects on patient outcome, safety and experience. One proposed solution is to locate general practitioners to work in or alongside the emergency department (GPED). Several GPED models have been introduced, however, evidence of effectiveness is weak. This study aims to evaluate the impact of GPED on patient care, the primary care and acute hospital team and the wider urgent care system.Methods and analysisThe study will be divided into three work packages (WPs). WP-A; Mapping and Taxonomy: mapping, description and classification of current models of GPED in all emergency departments in England and interviews with key informants to examine the hypotheses that underpin GPED. WP-B; Quantitative Analysis of National Data: measurement of the effectiveness, costs and consequences of the GPED models identified in WP-A, compared with a no-GPED model, using retrospective analysis of Hospital Episode Statistics Data. WP-C; Case Studies: detailed case studies of different GPED models using a mixture of qualitative and quantitative methods including: non-participant observation of clinical care, semistructured interviews with staff, patients and carers; workforce surveys with emergency department staff and analysis of available local routinely collected hospital data. Prospective case study sites will be identified by completing telephone interviews with sites awarded capital funding by the UK government to implement GPED initiatives. The study has a strong patient and public involvement group that has contributed to study design and materials, and which will be closely involved in data interpretation and dissemination.Ethics and disseminationThe study has been approved by the National Health Service East Midlands—Leicester South Research Ethics Committee: 17/EM/0312. The results of the study will be disseminated through peer-reviewed journals, conferences and a planned programme of knowledge mobilisation.Trial registration numberISRCTN51780222.

scholarly journals Length of stay as quality indicator in emergency departments: analysis of determinants in the German Emergency Department Data Registry (AKTIN registry)

2022 ◽  
Author(s):  
Ronny Otto ◽  
Sabine Blaschke ◽  
Wiebke Schirrmeister ◽  
Susanne Drynda ◽  
Felix Walcher ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Departments ◽  
Patient Flow ◽  
Management Strategies ◽  
Organizational Factors ◽  
Related Factors ◽  
Adult Age ◽  
Emergency Department Data ◽  
Data Registry

AbstractSeveral indicators reflect the quality of care within emergency departments (ED). The length of stay (LOS) of emergency patients represents one of the most important performance measures. Determinants of LOS have not yet been evaluated in large cohorts in Germany. This study analyzed the fixed and influenceable determinants of LOS by evaluating data from the German Emergency Department Data Registry (AKTIN registry). We performed a retrospective evaluation of all adult (age ≥ 18 years) ED patients enrolled in the AKTIN registry for the year 2019. Primary outcome was LOS for the whole cohort; secondary outcomes included LOS stratified by (1) patient-related, (2) organizational-related and (3) structure-related factors. Overall, 304,606 patients from 12 EDs were included. Average LOS for all patients was 3 h 28 min (95% CI 3 h 27 min–3 h 29 min). Regardless of other variables, patients admitted to hospital stayed 64 min longer than non-admitted patients. LOS increased with patients’ age, was shorter for walk-in patients compared to medical referral, and longer for non-trauma presenting complaints. Relevant differences were also found for acuity level, day of the week, and emergency care levels. We identified different factors influencing the duration of LOS in the ED. Total LOS was dependent on patient-related factors (age), disease-related factors (presentation complaint and triage level), and organizational factors (weekday and admitted/non-admitted status). These findings are important for the development of management strategies to optimize patient flow through the ED and thus to prevent overcrowding.

scholarly journals Helicopter Emergency Ambulance Service (HEAS) Transfer: An Analysis of Trauma Patient Case-Mix, Injury Severity and Outcome

2007 ◽  
Vol 89 (5) ◽  
pp. 513-516 ◽  
Author(s):  
JTK Melton ◽  
S Jain ◽  
B Kendrick ◽  
SD Deo
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Ambulance Service ◽  
Case Mix ◽  
Trauma Patients ◽  
Patient Case ◽  
Average Hospital ◽  
Acute Setting ◽  
Time Period ◽  
Emergency Ambulance

INTRODUCTION A retrospective review of all patients transferred by helicopter ambulance to the Great Western Hospital over a 20-month period between January 2003 and September 2004 was undertaken to establish the case-mix of patients (trauma and non-trauma) transferred and the outcome. PATIENTS AND METHODS Details of all Helicopter Emergency Ambulance Service (HEAS) transfers to this unit in the study time period were obtained from the three HEAS providers in the area and case notes were reviewed. RESULTS There were 156 trauma patients transferred (total 193) in the study period with 111 cases identified for analysis with a mean age of 33 years (range, 1–92 years). Average Injury Severity Score on admission was 12 (range, 1–36). Forty-five patients were discharged home from the emergency department, 24 cases had operation, 10 patients required ICU care and 2 were pronounced dead in the emergency department. Average hospital stay following HEAS transfer was 2.97 days (range, 0–18 days). DISCUSSION Helicopter ambulance transfer in the acute setting is of debated value. Triage criteria are at fault if as many as 41% of patients transferred are being discharged home from casualty having incurred the financial cost of helicopter transfer. We suggest that the triage criteria for helicopter emergency transfer should be reviewed.

scholarly journals Using routine emergency department data for syndromic surveillance of acute respiratory illness before and during the COVID-19 pandemic in Germany, week 10-2017 and 10-2021

2021 ◽  
Author(s):  
T Sonia Boender ◽  
Wei Cai ◽  
Madlen Schranz ◽  
Theresa Kocher ◽  
Birte Wagner ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Departments ◽  
Syndromic Surveillance ◽  
Virus Disease ◽  
Respiratory Illness ◽  
Acute Respiratory Illness ◽  
Case Definitions ◽  
Emergency Department Data ◽  
Duration Magnitude ◽  
Icd 10

Introduction: To better assess the epidemiological situation of acute respiratory illness in Germany over time, we used emergency department data for syndromic surveillance before and during the COVID-19 pandemic. Methods: We included routine attendance data from emergency departments who continuously transferred data between week 10-2017 and 10-2021, with ICD-10 codes available for >75% of the attendances. Case definitions for acute respiratory illness (ARI), severe ARI (SARI), influenza-like illness (ILI), respiratory syncytial virus disease (RSV) and Coronavirus disease 2019 (COVID-19) were based on a combination of ICD-10 codes, and/or chief complaints, sometimes combined with information on hospitalisation and age. Results: We included 1,372,958 attendances from eight emergency departments. The number of attendances dropped in March 2020, increased during summer, and declined again during the resurge of COVID-19 cases in autumn and winter of 2020/2021. A pattern of seasonality of acute respiratory infections could be observed. By using different case definitions (i.e. for ARI, SARI, ILI, RSV) both the annual influenza seasons in the years 2017-2020 and the dynamics of the COVID-19 pandemic in 2020-2021 were apparent. The absence of a flu season during the fall and winter of 2020/2021 was visible, in parallel to the resurge of COVID-19 cases. The proportion of SARI among ARI cases peaked in April-May 2020 and November 2020-January 2021. Conclusion: Syndromic surveillance using routine emergency department data has the potential to monitor the trends, timing, duration, magnitude and severity of illness caused by respiratory viruses, including both influenza and SARS-CoV-2.

scholarly journals Use of the Emergency Ambulance Service to an Inner City Accident and Emergency Department – a Comparison of General Practitioner and ‘999’ Calls

1991 ◽  
Vol 84 (12) ◽  
pp. 726-727 ◽  
Author(s):  
A G Pennycook ◽  
R M Makower ◽  
W G Morrison
Keyword(s):  
Emergency Department ◽  
Inner City ◽  
Hospital Setting ◽  
Ambulance Service ◽  
Inappropriate Use ◽  
Accident And Emergency ◽  
Emergency Ambulance ◽  
Accident And Emergency Department ◽  
A Prospective Study ◽  
Effective Use

Over a 2-week period a prospective study was undertaken of patients brought to an inner city accident and emergency department by the emergency ambulance service. Criteria for assessing the appropriateness of use of the emergency ambulance service are not well defined and at worst entirely subjective. The author's finding that, of patients attending after a ‘999’ call, 49.8% were discharged with no follow-up suggests that many of these journeys represented inappropriate use of the emergency ambulance service. Close liaison between senior medical staff and the emergency ambulance service may allow more appropriate and effective use of the service, improving patient care in the pre-hospital setting.

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