title: Quality of coding diagnoses in emergency departments: effects on mapping the public's health.
abstract: BACKGROUND
  Emergency department (ED) attendees reflect the health of the population served by that hospital and the availability of health care services in the community.
  
  
  OBJECTIVE
  To examine the quality and accuracy of diagnoses recorded in the ED to appraise its potential utility as a guage of the population's medical needs.
  
  
  METHODS
  Using the Delphi process, a preliminary list of health indicators generated by an expert focus group was converted to a query to the Ministry of Health's database. In parallel, medical charts were reviewed in four hospitals to compare the handwritten diagnosis in the medical record with that recorded on the standard diagnosis "pick list" coding sheet. Quantity and quality of coding were assessed using explicit criteria.
  
  
  RESULTS
  During 2010 a total of 17,761 charts were reviewed; diagnoses were not coded in 42%. The accuracy of existing coding was excellent (mismatch 1%-5%). Database query (2,670,300 visits to 28 hospitals in 2009) demonstrated potential benefits of these data as indicators of regional health needs.
  
  
  CONCLUSIONS
  The findings suggest that an increase in the provision of community care may reduce ED attendance. Information on ED visits can be used to support health care planning. A "pick list" form with common diagnoses can facilitate quality recording of diagnoses in a busy ED, profiling the population's health needs in order to optimize care. Better compliance with the directive to code diagnosis is desired.
authors.affiliation: Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. limorad@bgu.ac.il
authors.forename: Limor
authors.initials: L
authors.lastname: Aharonson-Daniel
authors.affiliation: Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Dagan
authors.initials: D
authors.lastname: Schwartz
authors.affiliation: PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Tzipi
authors.initials: T
authors.lastname: Hornik-Lurie
authors.affiliation: Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Israel.
authors.forename: Pinchas
authors.initials: P
authors.lastname: Halpern
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D059019:Clinical Coding; D016208:Databases, Factual; D003697:Delphi Technique; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007557:Israel; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D055815:Young Adult