title: Identifying emergency-sensitive conditions for the calculation of an emergency care inhospital standardized mortality ratio.
abstract: OBJECTIVE
  Hospital standardized mortality ratios are used for hospital performance assessment. As a first step to develop a ratio variant sensitive to the outcome of patients admitted from the emergency department (ED), we identified International Classification of Diseases, 10th Revision, Canada diagnosis groups in which high-quality ED care would be expected to reduce inhospital mortality (emergency-sensitive conditions).
  
  
  METHODS
  To identify emergency-sensitive conditions, we assembled a multidisciplinary panel of emergency care providers and managers (n=14). Using a modified RAND/University of California, Los Angeles Appropriateness Method, 3 rounds of independent ratings including a teleconference were conducted from May to October 2012. Panelists serially rated diagnosis groups included in the Canadian hospital standardized mortality ratio (n=72) according to the extent ED management influences mortality.
  
  
  RESULTS
  The panel rated ED care as potentially reducing patient mortality for 37 diagnosis groups (eg, sepsis) and morbidity for 43 diagnosis groups (eg, atrial fibrillation) and rated timely ED care as critical for 40 diagnosis groups (eg, stroke). Panelists also identified 47 diagnosis groups (eg, asthma) not included in the Canadian hospital standardized mortality ratio in which mortality could potentially be decreased by ED care.
  
  
  CONCLUSIONS
  We identified 37 diagnosis groups representing emergency-sensitive conditions that will enable the calculation of a hospital standardized mortality ratio relevant to emergency care.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: siberth@me.com.
authors.forename: Simon
authors.initials: S
authors.lastname: Berthelot
authors.affiliation: Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Eddy S
authors.initials: ES
authors.lastname: Lang
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Hude
authors.initials: H
authors.lastname: Quan
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
mesh_terms: D026683:Advisory Committees; D004630:Emergencies / Q000145:classification / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D019984:Quality Indicators, Health Care / Q000592:standards* / Q000706:statistics & numerical data