Automated versus manual audit in the emergency department.
OBJECTIVE
The purpose of this paper is to compare data collected by automated form processing with manual data collection for clinical indicators (CIs) in paediatric emergency medicine.


METHODS
Paediatric patients presenting with croup, asthma, bronchiolitis, head injury and gastroenteritis in August 2006 were identified by ICD 9 coding and a traditional manual audit was performed by two data collectors. Data were collected on a total of 16 CIs for these five illnesses. Manual audit data were then compared to information collected for this same patient population using TELEform, an automated forms processing (AFP) system that had been employed for over two years.


RESULTS
Teleform data were only available for 24 patients compared to information for 127 patients identified by ICD 9 coding and manual audit. Teleform data overestimated compliance with clinical guidelines by 17 percent giving an overall departmental agreement with CIs of 90.6 percent compared to 73.5 percent in the manual audit. Additionally, manual audit demonstrated that when the clinical guideline was incorporated into the clinical record, compliance was 92.5 percent compared to 51.3 percent when it was not.


CONCLUSIONS
This single center study demonstrates that data collected by AFP such as TELEform, overestimate emergency department performance regarding CIs compliance. Departments that use automated data collection tools need to establish relationships between such data and data collected via more traditional auditing methods.
Doherty
Steven
S
Rural Clinical School, University of Newcastle, Tamworth, Australia. Steven.Doherty@hnehealth.nsw.gov.au
Davis
Lin
L
Leschke
Paul
P
Valpiani
Anna
A
Whitely
Emma
E
Yarnold
Della
D
Stevens
Helen
H
D000293:Adolescent; D001315:Australia; D001988:Bronchiolitis / Q000175:diagnosis / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000628:therapy; D019091:Critical Pathways; D003440:Croup / Q000175:diagnosis / Q000628:therapy; D004636:Emergency Service, Hospital; D005759:Gastroenteritis / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008485:Medical Audit / Q000379:methods*; D008492:Medical Informatics Computing; D017410:Practice Guidelines as Topic