|Title:||Emergency Department and Emergency Services Patient-Level Information Reporting|
|Document ID:||Operational Directive OD 0066/07|
|Date of issue:||Tuesday, 7 August 2007|
|Status:||NO LONGER APPLICABLE|
|Description:||The purpose of this bulletin is to describe the operating rules and reporting requirements for Health Services in Western Australia in relation to activity in Emergency Departments.|
|Legal requirements:||To ensure reporting meets the requirements of the Australian Health Care Agreement (2003-2008)
|Applicable to:||All public hospitals in Western Australia and Joondalup and Peel Health Campuses.|
|Period of effect:||from 1 July 2007 to 1 July 2009|
|Review date:||1 July 2009|
|Authorised by:||Dr Neale Fong, DIRECTOR GENERAL, DEPARTMENT OF HEALTH, 07-Aug-2007|
|Print version:||View print version|
Emergency Department and Emergency Services Patient-Level Information Reporting1.Distribution
For attention of all public hospitals in Western Australia and Joondalup and Peel Health Campuses.
The purpose of this bulletin is to describe the counting and reporting rules for services provided in Emergency Departments and Emergency Services to public patients who have not been formally admitted to the hospital, in order to meet the reporting requirements of:
Accurate information is required on emergency activity as provided by hospitals and health services. The data are used to quantify activity within Emergency Departments and Emergency Services across the state as well as informing planning and resourcing decisions.
An Emergency Department is an area in a hospital that provides triage, assessment, care and/or treatment for patients suffering from medical condition/s and/or injury. Emergency Services also provide these services however this activity is not necessarily in a set area of a hospital.
Since 2002-03 data have been collected centrally at patient-level for the statewide Emergency Department Data Collection (EDDC). As a by-product the EDDC is also used to meet DOHís national reporting requirements for the Non Admitted Patients Emergency Department National Minimum Data Set (NAPED NMDS).
4. Scope of patient-level reporting required for services provided in Emergency Departments/Services
Data relating to activity in Emergency Departments/Services are collected in a centralised statewide collection even if patients are subsequently admitted. Patients not meeting the criteria for an admitted patient, as defined in Technical Bulletin 17, may receive treatment that was unplanned and performed in a designated Emergency Department within a hospital or by an Emergency Service.
Patients who are planned returns 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 users this is the Ambulatory, Other and Domiciliary module.
The Funding Source classifications for the patient should include all categories, except for ĎPrivate Patientí, which should not be selected for a non-admitted emergency event at public hospitals.
The scope of patient-level reporting for emergency activity is limited to services provided at designated hospitals, that is in Emergency Departments. Nursing Posts and other areas that provide Emergency Services are not included in current reporting however, data is to be provided from these sites.
Patients who are admitted via the Emergency Department either into a holding or observation ward are in scope for the EDDC.
A patient who is already admitted and returns (from a ward or HITH) to the Emergency Department for a procedure (e.g. to have intravenous cannula re-sited) is in scope and this activity is to be captured in the Emergency Department electronic system (see instruction below 4.5).
4.1 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 OD0067/07). Reporting of counts of emergency activity via the HA215B will continue until further notice.
The HA215D and HA215E forms have been discontinued from 1 July 2006.
4.2 Responsibility for data provision
Details of emergency activity should be submitted to DOH, Information Collection and Management (ICAM) by the third working day of the following month. For example July 2007 information is required by the third working day of August 2007.
Arrangements have been made for Systems Application Managers of TOPAS and HCARe to send the data by electronic extracts. The Systems Application Managers for TOPAS and HCARe at InfoHEALTH/Alliance are responsible for ensuring that the emergency data extracts or downloads are forwarded on the dates specified above.
Systems Support, ICAM is responsible for ensuring that EDIS data is extracted on a daily basis.
Health Services are responsible for ensuring that patient data is accurate and is entered to meet the timeframe outlined above i.e. all data entry to be completed by the end of the 2nd working day of the month.
Systems Application Managers and Health Services are responsible for ensuring that ICAM is notified of any changes made to data elements and/or values, e.g. adding a value to a table. Any additional codes should only be implemented after consultation and agreement with relevant parties including Systems Application Managers and ICAM.
4.3 Definition: Non-admitted patient
A non-admitted patient is a patient who receives care at a hospital or health service but has not undergone the hospitalís formal admission process. There are several categories of non-admitted patients; this Operational Directive describes emergency patients only.
4.4 Definition: Occasions of Service
Patients meeting the criteria for non-admitted patient may receive treatment in a designated department or clinic within a hospital. The current required measure of recording visits is an Ďoccasion of serviceí.
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.
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 score, 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 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. A presentation is a subset of 'attendance'.
All patients who attend are to have their triage time, arrival time, seen by nurse time and seen by doctor time recorded. These times are separate data elements that occur in sequence even though the actual time may be the same i.e. the person may be triaged on arrival so that triage time and arrival time are equal. The triage activity occurs before service commencement, which is the seen by nurse or doctor activity.
4.5 Triage and other coding
National Triage Scale
The triage score of patients who are treated or assessed should be reported. The National Triage Scale should be used to report the five urgency categories of the patient (see below). Emergency patients are triaged to assess the urgency of the required treatment. If the triage assessment is changed from say Code 3 to Code 2, then a triage score of Code 2 is to be recorded. The triage score can be changed up but not down, and should not be altered once the episode is complete.
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 telephone service conducted as a substitute for face-to-face contact with the patient because of special circumstances, for example the distance required to travel to a service provider, may be counted as a presentation. For this activity to be included in reporting, the service must have been provided by a clinician, the telephone call must have been longer than 5 minutes, a triage (1 to 5) must be recorded and the patient must be clerically registered.
If patients are referred to After Hours GP Clinics they are to be recorded in the emergency system. In capturing the data, Triage should be Code 5, and Episode End Status (Departure Status) should be entered as Referred to After Hours GP Clinic. Patients should be clerically registered where possible.
Other Triage Codes
Some hospitals use the triage field to record additional patient information including Dead on Arrival, Direct Admission and Inpatient. The codes shown below should be used if the Triage Field is used to record the additional information.
Patients who are Dead on Arrival and require some service from emergency clinicians are to be recorded. In capturing the data, Triage 6 is used then the Episode End Status (Departure Status) should be entered as Dead on Arrival, and Visit Type entered as Dead on Arrival.
Direct admission patients who require some service from emergency clinicians are to be recorded. In capturing the data, Triage 7 is used then the Episode End Status (Departure Status) should be entered as Admitted, and Visit Type entered as Direct Admission.
To denote a current inpatient or HITH patient, Visit Type codes of Current Inpatient or HITH, and Episode End Status (Departure Status) of Returned to Ward or HITH are to be used.
This approach will enable more detailed identification of the episode. The activity can then be included or excluded from emergency activity reporting, depending on requirements.
4.6 Reporting elements for the EDDC
The reporting elements for the statewide EDDC include all data elements required to meet State reporting needs and the data elements required by the Commonwealth for the NAPED NMDS reporting. A description of these data elements is included in Attachment 1.
All data elements listed in Attachment 1 are mandatory.
The EDDC Repository is being developed to hold additional data elements to meet local requirements.
Additional codes are not to be added without consultation and agreement between ICAM, InfoHEALTH/Alliance and the Health Services.
Should you have any queries, please contact the Manager, Non Admitted Data Collections, Health Data Collections, ICAM.
Dr Neale Fong
This circular last updated: Tuesday, 7 August 2007 at 4:10pm