Accuracy of real-time SNOMED-CT coding by clinicians in an urban tertiary emergency department: A retrospective cohort study.

OBJECTIVE: This study aimed to determine the accuracy of the reported diagnoses and procedures to the National non-Admitted Patient Collection (NNPAC) from Auckland City Hospital Adult Emergency Department, and whether there were disparities between Maori and non-Maori patients. METHODS: We audited 5788 (n = 594 Maori, 5194 non-Maori) visits in February 2021 to determine whether diagnoses and procedures were recorded and whether these were recorded differently for Maori compared to non-Maori. A random sample of case notes, stratified by five common chief presenting complaints (n = 114) were selected to compare clinician recording of diagnoses and procedures in real time, to those derived from the clinical notes by auditors blinded to the actual diagnosis and patient name and ethnicity. The New Zealand Emergency Department SNOMED-CT reference set was used to code diagnoses. RESULTS: Maori were less likely to have a diagnosis recorded when discharged from the ED compared to non-Maori, relative risk 1.48 (1.08, 2.04), p = 0.016 (n = 3045). Failure to record diagnoses was due to flaw in the system for extracting diagnoses from electronic notes, rather than failure to make a diagnosis. There was agreement in 111/114 cases for diagnosis: 53/56, 94.6% (95 %CI 85,99) for Maori, and 58/58, 100% (95 %CI 93,100) for non-Maori; p = 0.115. There was agreement in 60/114 cases for procedures completed: 31/56, 55.4% (95 %CI 42,66) for Maori, and 29/58, 50% (95 %CI 38,62) for non-Maori; p = 0.567. CONCLUSION: Maori were less likely to have a diagnosis recorded at discharge due to systemic bias in how we captured diagnoses electronically. Our system should change to remove this inequity. The diagnoses recorded using SNOMED-CT were mostly an accurate reflection of clinician's notes, while recording of procedures was poor.

Disposition disparities in an urban tertiary emergency department.

OBJECTIVE: To explore disparities between Maori and non-Maori patients with respect to triage acuity and disposition based on presenting complaint. METHODS: This was a retrospective review of 5788 (n = 594 Maori, n = 5194 non-Maori) ED visits in February 2021, extracted from the hospital data warehouse. RESULTS: Maori were triaged similarly to non-Maori but were less likely to be admitted compared to non-Maori: relative risk 0.87 (0.78, 0.97), P = 0.008. CONCLUSION: Maori were less likely to be admitted for similar presenting complaints, despite similar triage acuity. Further research is required to determine the reasons for this apparent inequity.

Examining emergency department inequities: Descriptive analysis of national data (2006-2012).

OBJECTIVE: Internationally, Indigenous and minoritised ethnic groups experience longer wait times, differential pain management and less evaluation and treatment for acute conditions within emergency medicine care. Examining ED Inequities (EEDI) aims to investigate whether inequities between Maori and non-Maori exist within EDs in Aotearoa New Zealand (NZ). This article presents the descriptive findings for the present study. METHODS: A retrospective observational study framed from a Kaupapa Maori positioning, EEDI uses secondary data from emergency medicine admissions into 18/20 District Health Boards in NZ between 2006 and 2012. Data sources include variables from the Shorter Stays in ED National Research Project database and comorbidity data from NZ's National Minimum Dataset. The key predictor of interest is patient ethnicity with descriptive variables, including sex, age group, area deprivation, mode of presentation, referral method, Australasian Triage Scale and trauma status. RESULTS: There were a total of 5 972 102 ED events (1 168 944 Maori, 4 803 158 non-Maori). We found an increasing proportion of ED events per year, with a higher proportion of Maori from younger age groups and areas of high deprivation compared to non-Maori events. Maori also had a higher proportion of self-referral and were triaged to be seen within a longer time frame compared to non-Maori. CONCLUSION: Our findings show that there are different patterns of ED usage when comparing Maori and non-Maori events. The next level of analysis of the EEDI dataset will be to examine whether there are any associations between ethnicity and ED outcomes for Maori and non-Maori patients.

Examining emergency department inequities: Do they exist?

OBJECTIVES: Ethnic inequities in health outcomes have been well documented with Indigenous peoples experiencing a high level of healthcare need, yet low access to, and through, high-quality healthcare services. Despite Maori having a high ED use, few studies have explored the potential for ethnic inequities in emergency care within New Zealand (NZ). Healthcare delivery within an ED context is characterised by time-pressured, relatively brief, complex and demanding environments. When clinical decision-making occurs in this context, provider prejudice, stereotyping and bias are more likely. The examining emergency department inequities (EEDI) research project aims to investigate whether clinically important ethnic inequities between Maori and non-Maori exist. METHODS: EEDI is a retrospective observational study examining ED admissions in NZ between 2006 and 2012 (5 976 126 ED events). EEDI has been designed from a Kaupapa Maori Research position. RESULTS: The primary data source is the existing Shorter Stays in Emergency Department National Research Project (SSED) dataset that will be combined with clinical information extracted from NZ's National Minimum Dataset. The key predictor variable is patient ethnicity with other covariates including: sex, age-group, area deprivation, mode of presentation, referral method, Australasian Triage Scale and the Multimorbidity Measure (M3 Index) for co-morbidities. Generalised linear regression models will be used to investigate the associations between pre-admission variables and the measures of ED care, and to examine the contribution of each measure of ED care on ethnic inequities in mortality. CONCLUSION: The present study will provide the largest, most comprehensive investigation of ED outcomes by ethnicity to date in NZ.