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What are emergency-sensitive conditions? A survey of Canadian emergency physicians and nurses

  • Simon Berthelot (a1) (a2), Eddy S. Lang (a3), Hude Quan (a2) and Henry T. Stelfox (a2) (a4)

Abstract

Objective: In a previous study, we assembled a multidisciplinary Canadian panel and identified 37 International Classification of Diseases-10-Canada Diagnosis Groups (DGs) for which emergency department (ED) management may potentially reduce mortality (emergency-sensitive conditions). Before using these 37 DGs to calculate a hospital standardized mortality ratio (HSMR) specific to emergency care, we aimed to test their face validity with ED care providers.

Methods: We conducted a self-administered web survey among Canadian emergency physicians and nurses between November 22 and December 31, 2012. All members (N=2,507) of the Canadian Association of Emergency Physicians and the National Emergency Nurses Association were surveyed. They were asked to agree or disagree (binary response) with the panel classification for each of the 37 DG emergency-sensitive conditions identified and provide free text responses to identify missing entities.

Results: A total of 719 ED providers (719 of 2,507, 29%) completed the survey, of whom 470 were physicians (470 of 1,407, 33%) and 232 were nurses (232 of 1,100, 21%). Information on professional status was not provided for 17 respondents. Of 37 DGs, 32 (e.g., A41 sepsis) were rated by more than 80% of respondents to be emergency-sensitive conditions. The remaining five DGs (e.g., E11 type 2 diabetes mellitus) were rated by 68.5 to 79.7% of the respondents to be emergency-sensitive conditions. Respondents suggested an additional 31 emergency-sensitive diagnoses.

Conclusion: We identified 37 emergency-sensitive DGs that had high face validity with emergency physicians and nurses, which will enable the calculation of an ED-HSMR.

Objectif: Dans une étude antérieure, un groupe d’étude pluridisciplinaire, canadien a relevé 37 groupes de diagnostics (GD) selon la Classification internationale des maladies–10–CA (adaptation canadienne), pour lesquels la prise en charge au service des urgences (SU) pouvait réduire la mortalité (maladies en phase critique au service des urgences [SU]). Toutefois, avant d’utiliser ces 37 GD pour calculer un ratio normalisé de mortalité hospitalière (RNMH) propre aux soins d’urgence, nous voulions en vérifier la validité apparente parmi les fournisseurs de soins d’urgence.

Méthode: Une enquête autoadministrée en ligne a été menée au sein du personnelmédical et infirmier d’urgence, au Canada, entre le 22 novembre et le 31 décembre 2012. Tous les membres (N=2507) de l’Association canadienne des médecins d’urgence et de la National Emergency Nurses Association ont été invités à y répondre. On leur a demandé d’indiquer, pour chacun des 37 GD de maladies en phase critique au SU, s’ils étaient d’accord ou non (réponse binaire) avec le groupe d’étude sur la sélection proposée, et de donner des réponses en formulation libre pour l’ajout d’autres diagnostics.

Résultats: Au total, 719 (719 sur 2507; 29%) fournisseurs de soins d’urgence, dont 470 médecins (470 sur 1407; 33%) et 232 infirmières/infirmiers (232 sur 1100; 21%), ont répondu au questionnaire. Dix-sept répondants n’ont pas fourni de renseignements quant à leur statut professionnel. Sur les 37 GD de maladies en phase critique au SU, 32 (ex.: A41–Sepsis) ont recueilli l’appui de plus de 80% des répondants; pour ce qui est des 5 autres GD de maladies en phase critique au SU (ex.: E11–Diabe` te sucréde type 2), l’appui des répondants variait de 68.5% à 79.7%. Enfin, les participants ont suggéré l’ajout de 31 diagnostics de maladies en phase critique au SU sur la liste préétablie.

Conclusion: La validité apparente de 37 GD de maladies en phase critique au SU a fait l’objet d’un large consensus au sein du personnel médical et infirmier d’urgence, ce qui a permis de calculer un RNMH-SU.

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Copyright

Corresponding author

Correspondence to: Dr. Simon Berthelot, Department of Emergency Medicine, CHU de Québec–CHUL, 2705 Boul. Laurier, Québec, QC G1V 4G2; siberth@me.com.

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