Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-13T04:56:54.420Z Has data issue: false hasContentIssue false
  • English
  • Français

Development of the Canadian Emergency Department Diagnosis Shortlist

Published online by Cambridge University Press:  21 May 2015

Bernard Unger ,
Marc Afilalo ,
Jean François Boivin ,
Michael Bullard ,
Eric Grafstein ,
Michael Schull ,
Eddy Lang ,
Antoinette Colacone ,
Nathalie Soucy  and
Xiaoqing Xue
...Show all authors
Bernard Unger*
Affiliation:
Emergency Multidisciplinary Research Unit, McGill University, Montréal, Que.
Marc Afilalo
Affiliation:
Emergency Multidisciplinary Research Unit, McGill University, Montréal, Que.
Jean François Boivin
Affiliation:
Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, McGill University, Montréal, Que.
Michael Bullard
Affiliation:
University of Alberta Hospital, University of Alberta, Edmonton, Alta.
Eric Grafstein
Affiliation:
St. Paul's Hospital, University of British Columbia, Vancouver, BC
Michael Schull
Affiliation:
Sunnybrook Health Sciences Centre and Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ont.
Eddy Lang
Affiliation:
Alberta Health Services, University of Calgary, Calgary, Alta.
Antoinette Colacone
Affiliation:
Emergency Multidisciplinary Research Unit, McGill University, Montréal, Que.
Nathalie Soucy
Affiliation:
Emergency Multidisciplinary Research Unit, McGill University, Montréal, Que.
Xiaoqing Xue
Affiliation:
Emergency Multidisciplinary Research Unit, McGill University, Montréal, Que.
Eli Segal
Affiliation:
Emergency Multidisciplinary Research Unit, McGill University, Montréal, Que.
*
Emergency Department, McGill University, Rm. D-010, Jewish General Hospital, 3755 Cote Ste. Catherine Rd., Montréal QC H3T 1E2; bernard.unger@mcgill.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

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.

Keywords

diagnosis classificationemergency departmentadministration
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 4 , July 2010 , pp. 311 - 319
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

References

REFERENCES

1.Nilsson, G, Petersson, H, Ahlfeldt, H, et al.Evaluation of three Swedish ICD-10 primary care versions: reliability and ease of use in diagnostic coding. Methods Inf Med 2000;39:325–31.Google ScholarPubMed
2.Building on values. The future of health care in Canada. Commission on the Future of Health Care in Canada. Ottawa (ON): National Library of Canada; 2002. Available: http://www.cbc.ca/healthcare/final_report.pdf (accessed 2008 Mar. 2).Google Scholar
3.Coonan, KM. Medical informatics standards applicable to emergency department information systems: making sense of the jumble. Acad Emerg Med 2004;11:1198–205.Google Scholar
4.Innes, G, Murray, M, Grafstein, E; for the Canadian Emergency Department Information System (CEDIS) working group. A consensus-based process to define standard national data elements for a Canadian emergency department information system. CJEM 2001;3:277–84.Google Scholar
5.Grafstein, E, Unger, B, Bullard, M, et al.; for the Canadian Emergency Department Information System working group. Canadian Emergency Department Information System (CEDIS) Presenting Complaint List (Version 1.0). CJEM 2003;5:27–34.CrossRefGoogle Scholar
6.Grafstein, EJ, Bullard, MJ, Warren, D, et al.Revision of the Canadian Emergency Department Information System (CEDIS) Presenting Complaint List (Version 1.1). CJEM.2008;10:151–61.CrossRefGoogle ScholarPubMed
7.Bullard, MJ, Unger, B, Spence, J, et al.Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) adult guidelines. CJEM. 2008;10:136–42.Google Scholar
8.Health data standards & systems in Victorian hospitals. Victorian emergency minimum dataset (VEMD). State Government of Victoria, Australia, Department of Human Services; 2010. Available: http://www.health.vic.gov.au/hdss/vemd/index.htm(accessed 2008 Jun. 29).Google Scholar
9.Lestavel, P, Smaiti, N; pour la SFMU et la commission d’évaluation. Le Thésaurus de Médecine d’Urgence 2001. Paris (France): Service d’accueil et de traitement des urgences CHRU LILLE; 2000. Available: http://www.sfmu.org/fr/ressources/referentiels (accessed 2008 Jun. 29).Google Scholar
10.Smedby, B. Comparison of current shortlist used for OECD data collection with the new Eurostat shortlist. Brussels (Belgium): European Commission; 2010. Available: http://www.ec.europa.eu/health/ph_information/dissemination/hsis/hospital_4.pdf (accessed 2008 Jun. 29).Google Scholar
11.Emergency department classifications update. Coding Matters: Newsletter of the National Centre for Classification in Health 2002;9(2):1–35.Google Scholar
12.Britt, H, Angelis, M, Harris, E. The reliability and validity of doctor-recorded morbidity data in active data collection systems. Scand J Prim Health Care 1998;16:50–5.Google ScholarPubMed
13.Begier, EM, Sockwell, D, Branch, LM, et al.The National Capitol Region’s emergency department syndromic surveillance system: Do chief complaint and discharge diagnosis yield different results? Emerg Infect Dis 2003;9:393–6.CrossRefGoogle ScholarPubMed
14.National Ambulatory Care Reporting System (NACRS). Ottawa (ON): Canadian Institute for Health Information; 2007. Available: http://www.cihi.ca/cihiweb/en/downloads/nacrs_exec_summ_2008_2009_e.pdf (accessed 2010 May 21).Google Scholar
15.Afilalo, M, Berger, S, Hamel, P, et al.Guide de gestion de l’unité d’urgence. Québec (QC): Association des hôpitaux de Québec et Comité d’experts du groupe de coordination nationale des urgences du Québec, MSSS; 2000. Available: http://www.amuq.qc.ca/AxisDocument.aspx?id=14&langue=fr&download=true&document=Guide%20de%gestion%20de%201 (accessed 2008Mar. 23).Google Scholar
16.Parnanen, H, Kumpusalo, E, Takala, J. Primary health care ICD-a tool for general practice research. Int J Health Plann Mgmt 2000;15:133–48.Google Scholar
17.Jolicoeur, M. Un grand sous-traitant américain de services aux hôpitaux s’installe à Montréal. Les affaires 2008 Jan 26; p. 11.Google Scholar
18.Moskal, L. The implementation of ICD-10-CA and CCI in Canada. American Health Information Management Association; 2004. Available: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok3_005526.hcsp?dDocName=bok3_005526 (accessed 2008 May 15).Google Scholar
19.Meyers, S. Coder shortage goes straight to the bottom line. Chicago (IL): Hospital and Health Networks; 2004. Available: http://www.hhnmag.com/hhnmag_app/hospitalconnect/search/article.jsp?dcrpath=AHA/PubsNewsArticle/data/0401HHN_FEA_Workforce&domain=HHNMAG (accessed 2008 Jan. 31).Google Scholar
20.Health informatics and health information management: human resources report. Toronto (ON): Prism Economics and Analysis; 2009.Google Scholar
21.Muscatello, D, Travis, S. Using the international classification of diseases with HOIST. NSW Public Health Bull 2001;12:289–93.CrossRefGoogle ScholarPubMed
22.Smith, MW. Hospital discharge diagnoses: How accurate are they and their international classification of diseases (ICD) codes? N Z Med J 1989;102:507–8.Google Scholar
23.O’Malley, KJ, Cook, KF, Price, MD, et al.Measuring diagnoses: ICD code accuracy. Health Serv Res 2005;40:1620–39.CrossRefGoogle ScholarPubMed
24.Yao, P, Wiggs, BR, Gregor, C, et al.Discordance between physicians and coders in assignment of diagnoses. Int J Qual Health Care 1999;11:147–53.CrossRefGoogle ScholarPubMed
25.Bota, GW, Therrien, SA, Rowe, BH. A truncated E-code system for injury surveillance in the emergency department: description and clinometric testing. Acad Emerg Med 1997;4:291–6.Google Scholar
26.Edmeston, JT, Craib, K, Djurdjev, O, et al.The reliability of diagnostic codes used in a customized in house emergency medicine database — the New Emergency Resource Database (NERD). CJEM 1999;1:169–70.Google Scholar
27.Gorelick, MH, Knight, S, Alessandrini, EA, et al.Pediatric Emergency Care Applied Research Network. Lack of agreement in pediatric emergency department discharge diagnoses from clinical and administrative data sources. Acad Emerg Med 2007;14:646–52.Google Scholar
28.Fink, A, Kosecoff, J, Chassin, M, et al.Consensus methods: characteristics and guidelines for use. Am J Public Health 1984;74:979–83.Google Scholar
29.Campbell, SM, Hann, M, Roland, MO, et al.The effect of panel membership and feedback on ratings in a two-round Delphi survey: results of a randomized controlled trial. Medical Care 1999;37:964–8.Google Scholar
30.Lindsay, P, Schull, M, Bronskill, S, et al.The development of indicators to measure the quality of clinical care in emergency departments following a modified-Delphi approach. Acad Emerg Med 2002;9:1131–9.Google Scholar
31.Fleischauer, AT, Silk, BJ, Schumacher, M, et al.The validity of chief complaint and discharge diagnosis in emergency department-based syndromic surveillance. Acad Emerg Med 2004;11:1262–7.Google Scholar