Academic journal article Australian Health Review

Admission Time to Hospital: A Varying Standard for a Critical Definition for Admissions to an Intensive Care Unit from the Emergency Department

Academic journal article Australian Health Review

Admission Time to Hospital: A Varying Standard for a Critical Definition for Admissions to an Intensive Care Unit from the Emergency Department

Article excerpt

Introduction

Time spent in the emergency department (ED) before admission to a hospital bed is often considered an important key performance indicator (KPI).1 Delayed admission to the intensive care unit (ICU) from the ED may result in increased hospital mortality.2 Carter et al. have shown that times spent in the ED before admission to an ICU have been increasing in Australia over recent years.3 Elowever, the same authors noted that it was possible that criteria for recording time of ED admission were different at different hospitals. Because such KPIs are critical for system-wide decision-making, the data and standards used to define them should be consistent and similar across all hospitals, to allow for appropriate comparison.

Although acceptable standards for maximum time spent in the ED vary across the states in Australia, standards have been set internationally. The limit of 4 h was first introduced in the UK,4 and has been trialled in Western Australia since April 2009. As part of the Australian Health Reform and National Access Targets, this is currently being rolled out across the remaining states between 2011 and 2015, with financial incentives for meeting this target.5

The Australia and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD) is a high quality database that records demographic, severity of illness and outcome data from adult ICU admissions6 from ~85% of Australian intensive care units. The ANZICS APD7 defines the time of admission to hospital as the 'Time at which the patient was admitted to the hospital for the episode of care which included the current episode of ICU care'.

It is unknown whether there is consistency in recording of the time of admission to hospital for data submitted to ANZIC S and to what degree variation in defining this affects the subsequent time listed as spent waiting in the ED before admission to the ICU.

The aims of the present study were to determine: (1) the method by which 'time of admission' to hospital is defined for patients who are admitted to the ICU from the ED, at hospitals that submit data to the ANZICS Adult Patient Database; and (2) whether different methods for defining 'time of admission to hospital' affect the reported time spent in the ED before admission to ICU (for patients reported to the ANZICS Adult Patient Database).

Methods

The study was approved by the Alfred Hospital Ethics Committee (project 248/11).

Hospitals that listed admissions to the ICU from the ED between 1 January 2005 and 31 December 2009 were identified from the ANZIC S APD. A minimum of 50 admissions to the ICU from the ED over the 5-year period was selected as an arbitrary cut-off for inclusion because of a concern that hospitals who had submitted only a low number of patients might either have incomplete data, inconsistent data collection methods or poor data quality.

The majority of hospitals collect data for submission using AORTIC,8 a free software program provided by ANZICS. Data is entered manually into AORTIC (by paid data collectors, medical or nursing staff) with no link to other hospital- or state-based data systems and is de-identified before submission. ANZICS does not specify the source from which admission times may be obtained.

Between May 2010 and October 2010, staff at each hospital were contacted to determine the method by which time of admission to hospital was estimated for patients admitted from the ED. Initially, the person responsible for submitting data from the ICU to ANZICS was contacted by email. If email responses were received where the primary contact was not confident of the admission time decision method, structured telephone interviews were conducted initially with the ICU staff responsible for data submission to ANZIC S, then with staff in the ED or medical records department. The person ultimately responsible for data entry was contacted in each case. All information was provided in confidence and in the belief that it was correct to the best knowledge of the individuals at the hospitals in question. …

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