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Administrative assessment in emergency medicine: a tool of impact
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicinevolume 18, Article number: P2 (2010)
The Department of emergency medicine was established one year ago. One of our main goals is to ensure correct initial treatment, stabilisation and referral to the correct speciality, of all patients admitted to the hospital. In optimising the process of triage and referral, all young doctors have to consult a coordinating doctor (i.e. a more experienced doctor) before initialising treatment, deciding on a diagnosis and referring to another speciality. This coordinating function is essential in the treatment of the patients and the patient flow in the emergency department. In order to improve the two coordinating doctors' (i.e. the authors) referral skills, a study monitoring the clinical outcome of all patients treated in a certain period was performed.
A review of all the patients admitted to the hospital during 5 random workdays was outlined. All cases were analysed by diagnosis and referred speciality, at discharge from the emergency department and at discharge from the hospital. Data was split into four main categories: 1) correct diagnosis, correct speciality; 2) incorrect diagnosis, correct speciality; 3) incorrect diagnosis, incorrect speciality; 4) immediate patient discharge. Further subdivisions were formed to analyse the results in more detail.
185 patients cases were analysed and categorised as followed; 1) 53%; 2) 30%; 3) 5%; 4) 12%.
Assessment of coordinating doctors, using patient outcome data is useful, in both an individual and in a general perspective. The method supports the coordinating doctor in understanding and developing diagnostic and referral skills in emergency clinical settings.
Our study showed that 93% of all the patients in the study were treated and referred in the most appropriate way, but the part of patients in group 1 was only 53% which leaves room for improvement.
To improve the communication between the young doctor and the coordinating doctor, a pocket guide was made. Future studies will test if this communicative tool can improve diagnostics and referral in the emergency department.