|Title:||Emergency Department and Emergency Services Patient-Level Data Collection and Reporting|
|Document ID:||Operational Directive OD 0205/09|
|Date of issue:||Thursday, 16 July 2009|
|Description:||The purpose of this bulletin is to describe the business rules for services provided in emergency departments to public patients to meet the reporting requirements of the Department of Health Western Australia.|
|Legal requirements:||To ensure reporting meets the requirements for all emergency department activity, such as the local Four Hour Rule Program and the national Australian Health Care Agreement.
|Applicable to:||All Western Australian Public Hospitals / Health Services, Joondalup Health Campus and Peel Health Campus for public patients.|
|Framework:||Information Management Policy Framework|
|Period of effect:||from 19 June 2009 to 1 June 2012|
|Review date:||1 July 2010|
|Authorised by:||Dr Peter Flett, DIRECTOR GENERAL, DEPARTMENT OF HEALTH WA, 07-Jul-2009|
|Print version:||View print version|
Emergency Department and Emergency Services Patient-Level Data Collection and Reporting
For the attention of all public hospitals in Western Australia and Joondalup and Peel Health Campuses.
The purpose of this bulletin is to describe the data collection and reporting rules for services provided to public patients in designated hospital Emergency Departments (ED) and Emergency Services in smaller hospitals, in order to meet the requirements for:
Data relating to activity in EDs have been collected in a centralised Statewide collection, the Emergency Department Data Collection (EDDC) since 2002-2003 although incomplete data are available from 2000-01.
The EDDC is used to provide data for several state and national requirements for ED data including health service planning, budget allocation, resource utilisation, revenue enhancement, state and national performance monitoring and reporting, and for research projects.
The EDDC is also used to meet DOH’s national reporting requirements for the Non Admitted Patients Emergency Department National Minimum Data Set (NAPED NMDS).
4.0 Responsibility for data collection and provision
Data Collection in the Health Services
Health Services are responsible for ensuring that reporting timeframes are met and for providing high quality ED activity information via their ED data collection systems (EDIS, TOPAS, HCARe/CMS and ePAS), so that such data can be extracted to the EDDC.
Data Capture by Information Management and Reporting (IMR)
EDIS data are extracted daily and include updated information. Information Management and Reporting Directorate (IMR) is responsible for ensuring that EDIS data are extracted at approximately 2am each day.
Systems Application Managers of TOPAS, HCARe/CMS and Peel Health Campus (ePAS) are responsible for sending data by electronic extracts to IMR on the third day of each month. In order to meet this timeframe, details of emergency activity should be completed by the second day of the month for the previous month, so that data can be extracted on the third day for transferring to the EDDC.
Changes to Data Collected
Systems Application Managers and Health Services are responsible for ensuring that early notification is to be provided to IMR of any changes required to be made to data elements and/or value domains in the collection of ED data, e.g. adding a new value to a value domain.. Common data elements must be defined and used consistently by stakeholders. Additional data elements should not be implemented until agreement has been reached between Systems Application Managers, Health Services and IMR.
5.0 Scope of patient-level reporting required for services provided in Emergency Departments/Services
The scope of patient-level reporting for emergency activity is limited to services provided to emergency patients at hospitals. These services could be provided through designated EDs or through Emergency Services at smaller hospitals. Nursing Posts and other areas that provide emergency services are not yet included in current reporting; however, data is to be provided from these sites where they operate in the absence of a hospital.
Patients who are admitted via the ED either into a holding or observation ward are within the scope of the EDDC. Data relating to activity in Emergency Departments/Services are collected in the centralised statewide collection (EDDC) for all patients attending, even if they are subsequently admitted.
Patients not meeting the criteria for an admitted patient, as defined below in 7.2 may receive treatment that was unplanned and performed in a designated ED or by an Emergency Service within a hospital.
Patients for whom a return visit is planned for treatment or follow up/reviews should, where possible, be serviced via the outpatient clinics, and data entered in the outpatient data collection system. For HCARe/CMS users, this is the Ambulatory, Other and Domiciliary module.
Under the National reporting rules1, when classifying “Funding Source” for patients, the category “Private Patient” from the value domain should not be selected for a non-admitted emergency event at public hospitals.
A patient who is already admitted and returns (from a ward or Hospital in the Home (HITH)) to the ED for a procedure (e.g. to have intravenous cannula re-sited) is within scope and this activity is to be captured in the ED electronic system where possible, with the patient identified as an existing inpatient (see instruction below under 8.0 – Data Quality).
6.0 Reporting of counts of emergency activity - HA215B, HA215D and HA215E
Information has been collected for non admitted patients for many years, using the HA215 reporting format (refer to Operational Directive 0067). Reporting of counts of emergency activity via the HA215B will continue until further notice. The HA215D and HA215E forms were discontinued from 1 July 2006.
This section of the Directive presents information about concepts related to Emergency Departments.
Attachment 1 to this Directive contains definitions for several data items collected about ED patients for the statewide EDDC. The data items include all those required to meet State reporting needs and required by the Commonwealth for the NAPED NMDS reporting. The complete list of data elements is included in Attachment 1.
All data elements listed in Attachment 1 are mandatory.
7.1 Emergency Department / Services
An Emergency Department is a set area in a hospital that provides triage, assessment, care and/or treatment for patients suffering from medical condition/s and/or injury. Emergency Services are also provided in smaller hospitals; however, this activity is not necessarily in a set area of the hospital.
7.2 Non-admitted Patient
A non-admitted patient is a patient who receives care at a hospital or health service but has not undergone the hospital’s formal admission process. There are several categories of non-admitted patients. This Operational Directive relates to emergency patients only.
7.3 Emergency Patient
Patients who require unplanned services, including those who have contacted a general practitioner and have been directed to the hospital by them, are emergency patients. This type of care is unplanned in that the illness or injury was sudden and the services unplanned. Thus the triage protocol should be followed.
A service does not have to be provided in person. A telephone service conducted as a substitute for face-to-face contact with the patient or the use of a Telehealth service may be counted as an occasion of service (see 7.4). The location of the provider and patient is not relevant. For this activity to be included in reporting, the usual criteria for an attendance must be met, that is, the service must have been provided by a clinician, a triage (1 to 5) must be recorded, and the patient must be clerically registered.
7.4 Occasion of Service2
Patients meeting the criteria for a non-admission may receive treatment in a designated department or clinic within a hospital. The required unit of measure for recording these visits is an “occasion of service”.
An occasion of service is defined as any examination, consultation, treatment or other service provided to a patient, or a group of patients, in each functional unit of a health service or hospital on each occasion such a service was provided.
In WA, occasions of service for emergency patients are categorised as attendances or presentations. Attendance figures are used for all local reporting. Presentations are used for National reporting.
An emergency attendance is recorded where a patient is registered in any manner in one of the electronic data collection systems. The patient may be missing a triage category, or may have a triage other than 1 to 5, or may not be clerically registered. Attendance counts may include patients who are Dead on Arrival (DOA) or those who did not wait to be seen.
An emergency presentation is an occasion of service where a patient is registered clerically, has a Unit Medical Record Number (UMRN), and has been triaged, indicated by a code of 1, 2, 3, 4 or 5. The total presentation count is a subset of the total attendance count.
7.7 National Triage Scale
Emergency patients are triaged to assess the urgency of the required treatment. The National Triage Scale should be used to report the urgency category of the patient from the values listed below.
If the triage assessment is changed from say 3 to 2, then a triage category of 2 is to be recorded. The triage category can be changed to a more urgent category, but caution should be taken if changing to a less urgent category, and should not be altered once the episode is complete. NOTE: Changing the triage may adversely affect the achievement of the target times for treatment.
7.8 Other Triage Codes (Optional Codes used in WA)
Some hospitals use triage to record additional patient information including classifying patients who are Dead on Arrival, directly admitted or current inpatients. The codes shown below should be used if triaging is used to record this additional information. This approach will enable more detailed recording of the episode so that the activity can be included or excluded from emergency activity reporting, depending on requirements.
8.0 Data quality
This section of the Directive presents information about the quality of data collected within Emergency Departments.
8.1 Critical data items
It is vital that ED patient level information is of high quality and best practice standards of accuracy, timeliness and consistency must be applied to meet reporting requirements. Poor quality ED data can result in poor patient care and inaccurate reporting of Performance Indicators, which may adversely affect outcomes. All patients who attend an ED are to have the relevant data entered in as timely a manner as possible. Date and time fields should be checked for correct order e.g. Discharge date/time should be after arrival date/time.
The following data items are critical to ensuring the accurate and complete reporting of local and national Performance Indicators:
8.2 Capturing data about patients admitted for observation
The DOH has been advised by the health services that patients admitted to the ED under an Emergency Physician (indicated by [Admitting doctor Type] = ‘EDADM’), are receiving appropriate care. Only those patients admitted for observation (i.e. they are not expected to be admitted to a general hospital ward) are to be recorded as admitted under the Emergency Physician. The table whereby Emergency Physicians are registered under the [Admitting doctor type] of ‘EDADM’ must be completed in a timely and correct manner, so that this information can be incorporated into the reporting process.
The consequence of not maintaining up-to-date registrations is that patients, who should be recorded as admitted for observation under the care of a registered Emergency Physician, will be recorded as an admission only and the length of episode in ED for these patients will be compromised. An incorrect length of episode in ED will impact on indicators such as those related to Access Block.
8.3 Data consistency - examples
To ensure reporting consistency for other critical items such as length of episode, transfer to other hospitals and unplanned re-attendances, data should be recorded as in the examples outlined in the following table:
NOTE: Additional codes are not to be created without consultation and agreement between IMR, Health Information Network and the Health Services, including ratification by the appropriate user groups.
Should you have any queries, please contact the Manager, Non Admitted Data Collections, IMR.
1 See PART 6 – ELIGIBILITY, PATIENT STATUS, REFERRALS AND ELECTION, item 39. An eligible patient presenting at a public hospital emergency department will be treated as a public patient.
Dr Peter Flett
This circular last updated: Thursday, 16 July 2009 at 12:07pm