Bernard Unger

Revision of the Canadian Emergency Department Information System (CEDIS) Presenting Complaint List version 1.1.

The original Canadian Emergency Department Information System (CEDIS) Presenting Complaint List was published in 2003. It has 161 complaints and is divided into 18 major categories. At the time of its development, there were a number of Canadian emergency departments (EDs) that had implemented partial emergency department information system (EDIS) solutions. Many departments were at the nascent stages of EDIS development. Since then, there has been a proliferation of ED information technology initiatives spearheaded by a national movement to address ED patient flow and efficiency issues. The 9/11 attack, bioterrorism threats, pandemic influenza concerns, and SARS have provided the impetus to develop syndromic surveillance systems that use a presenting complaint list, often derived electronically from a free-text complaint field. The adoption of the CEDIS Presenting Complaint List in various regions and provinces across the country underscores the utility and acceptance of a coded presenting complaint list. As the trend toward the implementation of EDIS progresses, the development of performance indicators has also occurred. This allows the measurement of various aspects of ED care. There is a strong reliance on the Canadian Emergency Department Triage and Acuity Scale (CTAS) in Canadian EDs to help identify the sickest patients in situations of overcrowding and limited manpower. As well, CTAS has become a measurement tool for identifying casemix groups for funding models and for comparing performance across different institutions. There has been a recent trend to marry the presenting complaint with the CTAS levels in order to increase the reliability of triage measurement across sites. The increase in use of the ED presenting complaint for ancillary reporting reflects the importance of having an accurate complaint list that is reliable, easy to use, understandable and still clinically useful for emergency care providers. The paediatric emergency medicine community has evaluated and adopted the idea of using a paediatric version of CTAS. There has also been work done on improving the interrater reliability of triage by introducing a

Guidance when Applying the Canadian Triage and Acuity Scale (CTAS) to the Geriatric Patient: Executive Summary

The first of the baby boomers reached the historic retirement age of 65 in 2011, however, even prior to this emergency department (ED) visits by the elderly were on the rise, correlating with our expanding life span. The average life expectancy for Canadian males/females born in 1992, 2002, and 2012 respectively is 75/81; 77/82, and 80/84 years as reported by Statistics Canada (http://www. statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/health26eng.htm). The proportion of the population over 65 is currently 12% and expected to rise to 20% by 2030, the year that all baby boomers will have reached the age of 65. Reductions in human mortality leading to extended lifespans reflect improved living standards, education, sanitation, housing, nutrition, public health, and advanced medical care. It has been proposed that medical advancements contributed 5 of the 30 year increase in life expectancy since 1900, and approximately 3.5 of the 7 year increase since 1950. From an ED perspective the impact of improved therapies for reversible life threatening conditions such as ST elevation infarcts (STEMIs), cerebrovascular accidents (CVAs) and severe trauma has complemented improved pre hospital care and ED processes to support rapid effective intervention vital to patient survival. More effective prevention and improved medical management has led to an increase in elderly ED patient complexity, often with multiple chronic diseases, varying degrees of cognitive impairment and mobility challenges. Older patient ED visits increased by greater than 30% in the decade between 1993 and 2003, with the number of ED visits over the age of 75 years of age relative to their proportion of the population even higher. This population is also subjected to prolonged ED lengths of stay, and have increased resource utilization and more frequent hospital admissions. Regarding triage and management challenges among older patients, the literature has identified a number of key differences from the general population, along with specific skills, knowledge and attitudes required to provide high quality care to older patients. Realities amongst elderly patients that make it more difficult to accurately triage and prioritize include:

Révision de la liste de raisons de consultation du Système canadien d’information de gestion des départements d’urgence (SIGDU), version 1.1

Publiée pour la première fois en 2003, la liste de raisons de consultation du système canadien d’information de gestion des départements d’urgence (SIGDU) comporte 161 raisons et est divisée en 18 grandes catégories. Au cours de son élaboration, de nombreux services d’urgence canadiens avaient mis en application des solutions partielles utilisant des versions personnalisées de systèmes d’information de gestion des urgences (SIGU). Plusieurs services d’urgence en étaient alors au stade initial du développement de tels systèmes. Depuis, la prolifération de ces systèmes s’inscrit dans la mouvance nationale pour régler les questions relatives au roulement des patients et à l’efficacité. Les événements du 11 septembre 2001, les menaces de bioterrorisme, les préoccupations relatives à une pandémie de grippe et le SRAS (syndrome respiratoire aigu sévère) ont donné un l’élan pour mettre au point des systèmes de surveillance syndromique employant une liste de raisons de consultation, souvent dérivée électroniquement d’un champ de texte en forme libre dans lequel est inséré le motif de consultation. L’adoption de la liste des raisons de consultation du SIGDU dans diverses régions et provinces met en évidence l’utilité et l’acceptation d’une telle liste codée. Alors que la tendance de mise en application de SIGU croissait, l’élaboration d’indicateurs de rendement permettant d’évaluer divers aspects des soins dans les urgences voyait le jour. Au Canada, les urgences se fient énormément à l’Échelle canadienne de triage et de gravité pour les services d’urgence (ÉTG) pour repérer les patients les plus malades, en situation d’engorgement et de main-d’œuvre limitée. De plus, l’ÉTG est devenue un outil d’identification de groupes clients pour l’élaboration de modèles de financement et un outil permettant la comparaison de rendements dans divers établissements. Récemment, une tendance a émergé : conjuguer la raison de consultation avec les niveaux de triage de l’ÉTG afin d’accroître la fiabilité des outils de triage dans les divers établissements. L’utilisation croissante de la liste de raisons de consultation pour la production de rapports auxiliaires reflète l’importance d’avoir une liste détaillée qui est fiable, facile à comprendre et à utiliser, tout en étant utile sur le plan clinique pour les fournisseurs de soins d’urgence. La communauté des médecins d’urgences pédiatriques a envisagé la possibilité d’utiliser une version de l’ÉTG