Figuring out emergency care provision
As the current system used to record data for emergency departments is approximately 40 years old, a new system will be implemented by October 2017
A national system to improve the recording of how and what urgent and emergency care is provided is being introduced later this year.
The Emergency Care Data Set (ECDS) will be implemented in consultant-led 24-hour emergency departments (EDs) and specialist EDs in England by October 2017.
It will be released to minor injury units, urgent care centres and walk-in centres by October 2018. There are also plans to use it for ambulance services.
The current system, the Accident and Emergency Commissioning Data Set (CDS type 010), was developed about 40 years ago, when the demand and work of EDs focused on minor injury and trauma. This out-of-date system is said to be failing to collect reliable and comparable information on why patients attend ED, their diagnosis and acuity.
Inaccuracies and difficulties
Only about 5% of all patients have a meaningful reason for their attendance at emergency care recorded. This means that understanding demand and use of emergency care is difficult.
In 2013 the Commons health committee highlighted the problem stating that ‘the system cannot accurately analyse the cause of the problem, still less resolve it, if it continues to fly blind’.
The new data will provide a more accurate, detailed and comprehensive picture of all emergency attendance.
The system has a limited number of options for clinicians to choose from and includes a standard measure of acuity.
The Royal College of Emergency Medicine, which is leading the NHS Digital project, says that the ECDS will allow improved audit and research, better tariffs for emergency care, clearer communication with patients, GPs and commissioners and better understanding of the needs of vulnerable patients.
The college says that the unpublished ECDS pilot has shown significant improvements in data quality.
Before to its introduction, 75% of recorded diagnoses were invalid, with ‘disease’ listed as the most common. After two months of the new scheme, all were valid, with concussion with no loss of consciousness the most common diagnosis.
Anna Crossley, RCN professional lead for acute, emergency and critical care
‘The care provided in emergency departments (EDs) has moved on from the time the original system was developed. The range of work we now do, partly due to advances in medicine and the increase in multiple comorbidities that people now live with in an ageing population, means a lot has changed and the data we record needs to reflect that.
'There is also a lot of variation across the country, so there needs to be a way of producing data that can be compared. With expansion of roles and advanced practice in emergency care, nurses will be involved with using this system.
'I hope that nurses have been involved in shaping its development during pilot trials and that all staff will get sufficient training away from the ED to use this properly, as the data will only be good if provided by people who understand how to use the system.’
Implications for nurses
Nurses involved with the data recording in EDs will soon come across the new ECDS. Key elements include reason for attending, chief complaint, acuity and diagnosis.
Currently, only half of patients have a diagnosis recorded in the data system, and most of these are not actually diagnoses, but vague symptoms and signs.
Instead, ECDS has a limited list of approximately 750 diagnoses, which is combined with a qualifier of ‘combined diagnosis’ or ‘suspected diagnosis’.
Acuity must also be recorded on a five-point scale. Currently there is no national measure of acuity.