‘Condom’, ‘Boxing Ring’ and ‘Mushroom’. These were just some of the diagnoses submitted for Emergency Department (ED) attendances, before the introduction of Emergency Care Data Sets (ECDS). It is no wonder really, that a system developed in the era of Bell Bottoms and Disco Fever, became unfit for purpose when faced with an increasingly pressured NHS.
As well as the rapidly increasing amount, the complexity and range of reasons why patients are attending EDs are vastly different than they were 50 years ago. We lost sight of the reason why people were coming to our hospitals and it impacted how we could support them.
Why did the old way stop working?
Data for ED attendances used to be collected using the ‘Systemised Nomenclature of Medicine – Clinical Terms’, far more commonly known as the SNOMED CT system. This system comprises a wealth of specialised, clinical vocabulary which is condensed into numerical codes. For example, an attendance reason of ‘Chronic Inflammation’ becomes M43000.
For professional coders and time-rich clinicians, this system offers an almost unlimited range of options that can create invaluable data. However, when used by clinical and admin staff, usually under severe pressure and with just precious minutes to spare, the sheer amount of these codes is overwhelming and difficult to navigate.
This resulted in reported attendance reasons that were confusing (such as 2% of all pregnancy-related problems occurring in males) or just plain impossible (‘Dutch Shepherd Dog Breed’ was once officially recorded!). In 2013 the Health Select Committee investigated the failings happening in Emergency Care, they declared:
“The system cannot accurately analyse the cause of the problem, still less resolve it, if it continues to ‘fly blind’. More accurate information about the causes of rising service pressures is not simply a management convenience; it is fundamental to the delivery of high-quality care.”Health Select Committee
Compounding the fact that the ways of data collecting needed to change.
The introduction of ECDS.
In 2017 the ECDS data collection was introduced. The Emergency Care Data Sets is a 4-part data capture designed to give an honest and trustworthy insight into what is happening at our Emergency Departments across England.
Reason for attendance
Previously, only around 5% of patients had realistic reasons recorded for their trip to an ED. At best, this data was meaningless and redundant in such low volumes. At worst, the absence of data could cause myths and assumptions to develop. ECDS now mandates that the reason for a patient’s attendance to the emergency department be completed.
The chief complaint is also recorded for each patient. This aims to gather more information about the key reason why they are seeking medical attention. ECDS allows an answer to be selected from any of the 138 options.
Prior to ECDS, there was no universal rating for acuity, or how serious a person’s illness or injury is, with different departments using different measures. Now, acuity must be rated on a 5-point scale. If no acuity is recorded, then the ultimate destination of the patient will be used to infer. This means that patients directed to Minors will get a lower acuity score and Majors, or Resus a higher one.
To fix the issues of misdiagnosis a limited list of approximately 750 diagnoses was developed. When used along with a ‘confirmed diagnosis’ or ‘suspected diagnosis’ option, the process became a lot easier and simpler for clinicians. There certainly weren’t any more Condoms or Mushrooms sending people to A&E!
What difference has it made?
In the pilot stage of ECDS, a study was done on the top 10 most popular diagnostic codes. Before the implementation of ECDS, 74% of the recorded ‘diagnoses’ were invalid. Afterwards, all of the diagnoses were valid!
The improvement of this data has many benefits, namely:
Better commissioning and policy decisions — Not having accurate and truthful data makes it hard for commissioners to make the right decisions when procuring patient services. The consistent, high-quality data collected through ECDS means services commissioned can be of most value to patients and make the biggest impact. Likewise, this richer data will also ensure policy decisions can be made with a holistic view of the current healthcare services and a better collection of post-implementation data can aid future decisions.
Better communication with patients — ECDS data is pre-populated into a letter that is presented to patients on discharge. Having clean quality data at patient touchpoints such as these minimises confusion and complaints.
Better workforce planning and training — Having robust records of diagnosing clinicians and treatment plans means more informed decisions can be made when it comes to workforce planning. This can help alleviate over or understaffing issues.
Public health decisions — We already know that injury is the biggest preventable cause of loss of life. While we have data on the most serious of injuries (remember the campaign around driving at 30mph to reduce death in a car accident? We got that from data!), we are lacking similar insights into the vast majority of them. ECDS will capture injury data and help fuel similar research and breakthroughs.
Keep an eye on our blog for the next in our ECDS series is live. We will be sharing key insights and data as well as how our digital triage solution for secondary care can make it easy and simple to collect this data straight from the patients, as part of their digital check-in.