Managing an emergency department by analysing HIS medical data: a focus on elderly patient clinical pathways.
BACKGROUND
The objective of this paper is to present complementary views of the activity of the emergency department for a specific group of patients. Once validated, these views will be used as decision support tools for better managing the department and providing better care delivery for this population. The views are produced from the data stored in Healthcare Information Systems that correspond potentially to a vast source of information for supporting decisions on management or public health issues.


METHODS
The study focuses on two groups of patients: the elderly population (over 75-years-old) and the under 75-year-old patients, at the Rennes hospital. The validation of the views is performed by comparing results for the two distinct groups. Relevant data were extracted from the Emergency Department database. Several analysis (like cusum chart) and representation tools (Graphviz) were used to study the patients' pathways, the dynamics of arrivals and the patients' characteristics.


RESULTS
The representations provided a synthetic, global and comprehensive view of the department activities, to the satisfaction of the clinicians. The study showed that ICD-10 coding, assigned at the patient's departure from the emergency department hence from all available known clinical data, is not appropriate for the elderly population as these patients are mainly diagnosed by "symptoms" and several solutions are proposed. Finally, it is stressed out that a proper delivery of care to elderly patients should require some level of scheduling in the emergency department that is by essence characterized by its non scheduled activity.
Rossille
Delphine
D
Faculté de Médecine, Université de Rennes 1, Rennes EA3888, France.
Cuggia
Marc
M
Arnault
Aude
A
Bouget
Jacques
J
Le Beux
Pierre
P
D000368:Aged; D019091:Critical Pathways / Q000458:organization & administration*; D003658:Decision Making, Computer-Assisted; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006299:Health Services for the Aged / Q000458:organization & administration; D006801:Humans; D007256:Information Systems / Q000706:statistics & numerical data*; D038801:International Classification of Diseases; D008297:Male