Triage, damned triage… and statistics: Sorting out redundancy and duplication within an Emergency Department Presenting Problem Code Set to enhance research capacity

Abstract

Background: Having a robust Emergency Department Presenting Problem Code Set (EDPPCS) is important for collecting and analysing data around Emergency Department (ED) activity, funding, bio-surveillance and research. This paper analyses the clinical utilisation of the current EDPPCS using two years worth of ED data collected as part of the larger state-wide Demand for Emergency Services Trends in Years 2010-2014 (DESTINY) project. This project proposes potential improvements in the current EDPPCS including a reduction in duplication and redundant clinical terms.

Methods: ED presenting problem fields were abstracted from the Emergency Department Data Collection (EDCC) Registry as entered by trained triage nurses. Frequencies of presenting problems were calculated and cross referenced with the EDPPCS. These were then categorised into clinically meaningful groups.

Results: There were 1,746,635million eligible ED presentations during January 2013 and December 2014 to 23 level 5 or 6 EDs. Of these, there were 64,849 unique presenting problem entries with 450 terms being used more than 100 times during the study period. Of those 450 terms, only 177 (39.3%) matched the current EDPPCS.

Conclusion: Future iterations of the EDPPCS should be based on the evidence presented making it shorter, more comprehensive and systematic leading to improved triage performance, usefulness in research and bio-surveillance.

Keywords: Emergency Department; Presenting problem; Triage.