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Comparison of methods used to quantify general practice-type patients in the emergency department: A tertiary
Meredith Borland1,2,3, Dmitry Skarin1, Yusuf Nagree3,4
1Department of Emergency Medicine, Princess Margaret Hospital, Perth, Western Australia, Australia.
Insights
Current methods for identifying general practice-type (GP-type) patients in pediatric emergency departments (EDs) are inconsistent. These GP-type presentations represent a significant workload, despite multifactorial causes.
Area of Science:
- Emergency Medicine
- Pediatric Health
- Health Services Research
Background:
- General practice-type (GP-type) presentations constitute a significant workload in pediatric emergency departments (EDs).
- Accurate quantification of GP-type patients is crucial for resource allocation and service planning.
- Existing methods for identifying GP-type patients in pediatric EDs lack robust validation.
Purpose of the Study:
- To compare the robustness of different methods used to quantify general practice-type (GP-type) patients in a pediatric ED.
- To assess the consistency and overlap of three distinct identification methods: Australian Institute of Health and Welfare (AIHW), Australasian College for Emergency Medicine (ACEM), and Diagnosis codes.
Main Methods:
- Retrospective analysis of 5 years (2010-2014) of ED Information System data from a tertiary pediatric hospital.
- Detailed analysis of 2014 presentations to statistically compare AIHW, ACEM, and Diagnosis methods for GP-type patient identification.
- Evaluation of presentation volume, consultation times, ED length of stay, and temporal distribution for GP-type patients.
Main Results:
- A total of 348,020 presentations were analyzed; GP-type patient identification varied widely (38%-68%) across the three methods.
- GP-type presentations decreased annually and had significantly shorter median consultation times and ED length of stay compared to the total sample.
- In 2014, only 36.6% of GP-type cases overlapped across all three methods, with substantial variation in exclusive flagging (ACEM 6.9%, AIHW 22.7%, Diagnosis 0.2%).
Conclusions:
- Current models for quantifying perceived GP-type presentations in pediatric EDs are inconsistent.
- All evaluated methods identified a substantial proportion of GP-type presentations, indicating a significant ED workload.
- The multifactorial reasons for these presentations warrant further investigation beyond simple access to general practice services.
Objective:
The aim of this study was to compare methods for quantifying general practice-type (GP-type) patients in a paediatric ED to determine the robustness of current identification methods.
Methods:
Data was sourced from the ED Information System for 5 years (2010-2014) from the tertiary paediatric hospital in Perth, Western Australia, Australia. A further detailed analysis of 2014 presentations established an independent sample for valid statistical comparison of the three methods used to identify GP-type patients: Australian Institute of Health and Welfare, ACEM and the Diagnosis.
Results:
A total of 348 020 patients presented in 2010-2014, with the percentage of GP-type patients identified varying from 38% to 68% by the three methods. Fewer GP-type presentations occurred over each consecutive year and had significantly lower median medical consultation times and ED length of stay when compared with the total presentation sample. GP-type presentations were evenly spread across the days and times of the week, with ACEM demonstrating only fewer presentations during office hours (P = 0.02). In 2014 there was only overlap in 36.6% cases for all three methods - 6.9% exclusively flagged by ACEM, 22.7% by Australian Institute of Health and Welfare and 0.2% by the Diagnosis method.
Conclusions:
We demonstrated that current models to quantify perceived GP-type presentations were inconsistent in paediatric patients. All methods flagged a high proportion of GP-type presentations, and although the reasons for these presentations are multifactorial and not easily explained by access to GP services alone, they do represent a significant workload in the paediatric ED.
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