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Methods of Documentation VI: Case Management Model01:15

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A Method for Grouping Emergency Department Visits by Severity and Complexity.

B Jason Theiling1, Kendrick V Kennedy1, Alexander T Limkakeng1

  • 1Duke University School of Medicine, Department of Emergency Medicine, Durham, North Carolina.

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|September 24, 2020
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Summary
This summary is machine-generated.

A new objective tool, the National Hospital Ambulatory Medical Care Survey-Emergency Severity Index (NHAMCS-ESI), was developed to measure emergency department (ED) visit complexity. This tool aids in assessing ED acuity and resource needs nationally.

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Area of Science:

  • Emergency Medicine
  • Health Services Research
  • Data Analytics

Background:

  • Emergency department (ED) triage aims to prioritize care and allocate resources effectively.
  • The Emergency Severity Index (ESI) is widely used, but a universal standard for ED triage is lacking.
  • This hinders objective assessment of national ED acuity and resource utilization trends.

Purpose of the Study:

  • To derive an ESI from National Hospital Ambulatory Medical Care Survey (NHAMCS) data, termed NHAMCS-ESI.
  • To evaluate the NHAMCS-ESI's performance in stratifying ED visit outcomes, including hospital admission, waiting times, and length of stay (LOS).

Main Methods:

  • Utilized 2010-2015 NHAMCS data to develop a measure of ED visit complexity.
  • Employed a stepwise algorithm mirroring ESI, using chief complaint, vitals, resources, interventions, and pain level.
  • Assessed associations between NHAMCS-ESI, waiting time, LOS, disposition, and compared it with the 'immediacy' variable.

Main Results:

  • NHAMCS-ESI categorized an estimated 805,726,000 ED visits, with most (42.5%) classified as level 3.
  • The categorization pattern differed from the 'immediacy' variable.
  • 89% of admitted patients were NHAMCS-ESI level 2-3; median waiting times and LOS correlated with acuity levels.

Conclusions:

  • An objective tool, NHAMCS-ESI, was developed to quantify ED visit complexity and resource use.
  • This tool can be validated for comparing ED visit complexity across different settings and time periods.
  • Facilitates standardized national assessment of ED patient acuity and resource demands.