Identifying Emergency-Sensitive Conditions for the Calculation of an Emergency Care Inhospital Standardized Mortality Ratio - 20/03/14
, Eddy S. Lang, MD b, Hude Quan, MD, PhD a, Henry T. Stelfox, MD, PhD a, cfor the
Panel on Emergency-Sensitive Conditions (PESC)
Abstract |
Study objective |
Hospital standardized mortality ratios are used for hospital performance assessment. As a first step to develop a ratio variant sensitive to the outcome of patients admitted from the emergency department (ED), we identified International Classification of Diseases, 10th Revision, Canada diagnosis groups in which high-quality ED care would be expected to reduce inhospital mortality (emergency-sensitive conditions).
Methods |
To identify emergency-sensitive conditions, we assembled a multidisciplinary panel of emergency care providers and managers (n=14). Using a modified RAND/University of California, Los Angeles Appropriateness Method, 3 rounds of independent ratings including a teleconference were conducted from May to October 2012. Panelists serially rated diagnosis groups included in the Canadian hospital standardized mortality ratio (n=72) according to the extent ED management influences mortality.
Results |
The panel rated ED care as potentially reducing patient mortality for 37 diagnosis groups (eg, sepsis) and morbidity for 43 diagnosis groups (eg, atrial fibrillation) and rated timely ED care as critical for 40 diagnosis groups (eg, stroke). Panelists also identified 47 diagnosis groups (eg, asthma) not included in the Canadian hospital standardized mortality ratio in which mortality could potentially be decreased by ED care.
Conclusion |
We identified 37 diagnosis groups representing emergency-sensitive conditions that will enable the calculation of a hospital standardized mortality ratio relevant to emergency care.
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| Please see page 419 for the Editor’s Capsule Summary of this article. |
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| A podcast for this article is available at www.annemergmed.com. |
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| Supervising editor: Donald M. Yealy, MD |
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| Author contributions: SB, ESL, HQ, and HTS designed the study, supervised its conduct, participated in developing the article, and approved the final article as submitted. SB, ESL, and HTS designed the data collection instruments and supervised the data collection. SB undertook the recruitment of the panelists and the administration of the survey, carried out the statistical analyses, drafted the initial article, and assumes responsibility for the integrity of the article. All coauthors of the Panel on Emergency-Sensitive Conditions group participated as panelists, revised the article, and approved its final version as submitted. SB takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist and provided the following details: The study was conducted at the Department of Community Health Sciences, University of Calgary; Division of Emergency Medicine, University of Calgary; and Institute of Public Health, University of Calgary. Grants were provided by the Division of Emergency Medicine, University of Calgary; and the Département de médecine familiale et de médecine d’urgence, Université Laval. |
Vol 63 - N° 4
P. 418 - avril 2014 Retour au numéro
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