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Pragmatic Risk Stratification Method to Identify Emergency Department Presentations for Alternative Care Service

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Summary
This summary is machine-generated.

Most emergency department visits are low-risk and can be redirected to alternative care pathways. Clustering International Statistical Classification of Diseases, Tenth Revision (ICD-10) codes by admission risk helps identify suitable patients for these pathways.

Keywords:
clinical decision-makingcluster analysiselectronic health recordsemergency services utilizationhealth servicestriage

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Area of Science:

  • Emergency Medicine
  • Health Services Research
  • Data Science in Healthcare

Background:

  • Optimizing prehospital emergency care resource allocation is crucial.
  • Redirecting non-urgent emergency department (ED) visits to alternative care service pathways (ACSPs) can improve efficiency.
  • Stratifying ED presentations by admission risk using diagnosis codes is a potential method for identifying suitable patients for ACSPs.

Purpose of the Study:

  • To cluster International Statistical Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes based on hospital admission risk.
  • To identify characteristics of ED presentations associated with these admission risk clusters.
  • To develop an exploratory classification system for identifying patient groups potentially suitable for ACSPs.

Main Methods:

  • Analysis of retrospective observational data from a tertiary care institution's ED database (2016-2020).
  • K-means clustering applied to group ICD-10 diagnosis codes by hospital admission outcomes.
  • Multivariable logistic regression used to assess the association between patient characteristics and cluster membership.

Main Results:

  • Four distinct clusters of ED presentations based on hospital admission risk were identified from 215,477 visits.
  • Cluster 1 (61% of visits) exhibited the lowest admission rate (4.7%), while Cluster 4 (5.5% of visits) had the highest (78%).
  • Higher Charlson Comorbidity Index scores, tachycardia, hyperthermia, recent surgery, and recent inpatient admission were associated with increased odds of higher-risk cluster membership.

Conclusions:

  • The majority of ambulatory ED presentations fall into low-risk clusters with a low probability of hospital admission.
  • Stratifying ICD-10 diagnosis codes by admission outcomes and frequency offers a structured approach for risk stratification.
  • This methodology can aid in identifying patients suitable for redirection to ACSPs, thereby optimizing emergency care resources.