Hospital Information System Research Articles

External validation of the MiGUTS nomogram for the prediction of bleeding control intervention after renal trauma.

The American Association for the Surgery of Trauma (AAST) renal trauma grading leads to a variable management of patients with high-grade renal injuries. For a better prediction of the risk for bleeding interventions, Keihani et al. introduced the multi-institutional genito-urinary trauma study (MiGUTS) renal trauma nomogram in 2019. The aim of this study was to conduct an external validation and generalization for all kidney trauma cases of the nomogram with a European cohort of a Swiss level 1 trauma center. We collected data from the clinical information system of the Kantonsspital Graubünden, Chur, Switzerland. All patients ≥ 18 years of age from 01.01.2008 to 01.12.2020 with a renal trauma who underwent computed tomography imaging of the abdomen were included. The descriptive analysis was performed by a t-test/Wilcoxon signed-rank test and a Chi-square test. The predictions of the nomogram were analysed by the Pearson correlation coefficient. The threshold of prediction of a bleeding intervention was optimized by a ROC analysis. Overall, 166 patients were included. Most patients were male (80.7%) with a median age of 44 years. Using the prediction from the MiGUTS nomogram developed by Keihani et al. we were able to identify a threshold with a sensitivity of 1.00, specificity of 0.87, positive predictive value of 0.44, negative predictive value of 1.00 and accuracy of 0.88. The MiGUTS nomogram by Keihani et al. demonstrated to be reliable in the prediction of an intervention for bleeding control in our validation study in a European cohort.

Enhancing Discharge Letter Completeness: Consultant Review via Encrypted Medical App

Abstract Background Ensuring comprehensive discharge letters is crucial for safe transitions from acute hospitals to community care. The 2013 National Standard for Patient Discharge Summary Information of the Health Information and Quality Authority (HIQA) 2013 outlines what items of information ought to be included in discharge summaries. On the wards, junior doctors often complete discharge documentation without consultant review. With technological advancements, tools like encrypted chat apps for medical care offer potential solution to improve communication and access to specialized reviews. We aimed to evaluate whether a specific app to access Consultant review could enhance discharge letter completeness. Methods We conducted a retrospective audit of discharge letters for inpatients admitted and discharged under a geriatric team between September 1st and December 23rd, 2023. The letters were divided in two groups: intervention, reviewed by a medical consultant, and control, including letters only signed off by non-consultant hospital doctors. Data access and approval were obtained from the hospital's Clinical Audit Committee; data collection utilized hospital information systems and Excel database, with minimal demographic data collected. SPSS facilitated data analysis. Each discharge letter was assessed for various items outlined in the HIQA guideline. The prevalence of inclusion of each item in each group was compared using non-paired Student t-test. Results We analysed 89 discharge letters, with 34 (38.2%) in the intervention group and 55 (61.7%) in the control group. Although most items showed no statistically significant difference between groups, the inclusion of investigation results significantly differed (91% in the intervention group versus 23% in the control group). Conclusion Our audit observed improved completeness of inclusion of investigation results in the intervention group. Future research should involve a larger sample from various teams to assess whether access to senior letter review via an encrypted app can consistently enhance discharge letter completeness.

Systematic development of a patient-reported ONCOlogical-ROUTinE-Screening (ONCO-ROUTES) procedure at the University Cancer Center Regensburg.

The evaluation of treatment success and progression in oncology patient-reported outcomes (PROs) is playing an increasingly important role. Meanwhile, PROs are a component of the certification requirements of the German Cancer Society for oncology centers. PROs are used to provide supportive therapy. There is currently no instrument that fully covers the requirements. At the University Hospital Regensburg (UKR), a digital ONCOlogical-ROUTinE-Screening (ONCO-ROUTES) procedure was developed in order to assess the need for supportive therapy in a standardized way and to provide patients with supportive interventions tailored to their needs. On the basis of current requirements and guidelines, the development of ONCO-ROUTES was supported by experts in focus groups and interviews, and digitalization was carried out in connection with the IT infrastructure. A Needs-based, Quality-of-life (QoL) and Symptoms Screening (NQS2) tool already established in the routine at the UKR was further developed into ONCO-ROUTES, which is made up of the domains therapy phase, nutrition, tobacco use, alcohol use, quality of life, general condition/functional status, physical activity, psychooncology, social services, and further support needs. By linking the digitized questionnaire to the hospital information system, the results are available for immediate use in routine operations and thus for the referral of patients for further supportive therapy. The digital PRO application ONCO-ROUTES is designed to involve patients in monitoring additional supportive needs and thus, improves supportive interdisciplinary treatment.

COVID-19 inpatient care performance in the unified health system, São Paulo state, Brazil: an application of standardized mortality ratio for hospitals’ comparisons

ObjectiveTo evaluate the variation in COVID-19 inpatient care mortality among hospitals reimbursed by the Unified Health System (SUS) in the first two years of the pandemic in São Paulo state and make performance comparisons within periods and over time.MethodsObservational study based on secondary data from the Hospital Information System. The study universe consisted of 289,005 adult hospitalizations whose primary diagnosis was COVID-19 in five periods from 2020 to 2022. A multilevel regression model was applied, and the death predictive variables were sex, age, Charlson Index, obesity, type of admission, Brazilian Deprivation Index (BrazDep), the month of admission, and hospital size. Then, the total observed deaths and total deaths predicted by the model’s fixed effect component were aggregated by each hospital, estimating the Standardized Mortality Ratio (SMR) in each period. Funnel plots with limits of two standard deviations were employed to classify hospitals by performance (higher-than-expected, as expected, and lower-than-expected) and determine whether there was a change in category over the periods.ResultsA positive association was observed between hospital mortality and size (number of beds). There was greater variation in the percentage of hospitals with as-expected performance (39.5 to 76.1%) and those with lower-than-expected performance (6.6 to 32.3%). The hospitals with higher-than-expected performance remained at around 30% of the total, except in the fifth period. In the first period, 64 hospitals (18.3%) had lower-than-expected performance, with standardized mortality ratios ranging from 1.2 to 4.4, while in the last period, only 23 (6.6%) hospitals were similarly classified, with ratios ranging from 1.3 to 2.8. A trend of homogenization and adjustment to expected performance was observed over time.ConclusionDespite the study’s limitations, the results suggest an improvement in the COVID-19 inpatient care performance of hospitals reimbursed by the SUS in São Paulo over the period studied, measured by the standardized mortality ratio for hospitalizations due to COVID-19. Moreover, the methodological approach adapted to the Brazilian context provides an applicable tool to follow-up hospital’s performance in caring all or specific-cause hospitalizations, in regular or exceptional emergency situations.

Changes in Child Psychiatry Presentations in the Second Wave of Coronavirus Disease 2019 Pandemic Compared to the Pre-pandemic Period and the First Wave: A Follow-up Study.

It is to examine how child psychiatry admissions, diagnosis and treatment trends in the second wave (September-December 2020/SD20) of the coronavirus disease 2019 (COVID-19) pandemic change compared to the pre-pandemic (SD19) and the first wave (March-June 2020/MJ20). Our study was planned as a multicenter, retrospective cross-sectional. Data were obtained from hospital computer systems databases. All patients admitted to the child psychiatry clinic on SD19 and SD20 constituted the study sample. In total, 5244 admissions were assessed. Of the admissions, 1459 were repeat exams, and 3785 were cases. 50.9% (n = 1927) of the cases came in SD19 and 49.1% (n = 1858) in SD20. In 2019, 37% (n = 825) of cases were girls, compared to 41.6% (n = 646) in 2020 (P = .004). The mean age of those who came in 2019 was 9.61 ± 4.08; The mean age of those who came in 2020 was 10.15 ± 5.38 (P = .002). In 2020, oppositional defiant conduct disorder, major depressive disorder, social anxiety disorder, obsessive-compulsive disorder, sleep-wake disorder, and dysthymia were significantly higher, while specific learning disorders, separation anxiety disorder, and intellectual disability were found to be lower. The decrease in second-wave admissions is less than in the first wave. In the second wave, externalizing and internalizing problems have increased. Drug therapy was prioritized. Postponing admissions was less in the second wave.

Evaluation of Serum Biochemical Parameters Primarily Liver Functions in Smokers: A Case-control Study

We investigated the effects of smoking on serum biochemical parameters primarily liver functions and metabolism. This is a case-control study. The case and control groups were formed by clinical randomization by using the data obtained from the hospital information system and patient records, including age, gender, height, and weight. Smokers were identified as the case group, while non-smokers were identified as the control group. In the comparisons of rates Chi-square tests were used and in the comparisons of averages, independent sample t and MANCOVA tests were used. When covariance factors such as age, gender, body mass index, and alcohol use were taken into consideration, it found that AST, ALT, and GGT were higher in smokers, whereas vitamin D, vitamin B12, and TSH were higher in non-smokers. We found that smoking has a negative effect on liver and bile functions, and vitamin D values are affected secondary to this negative effect

Data quality in hospital information systems: Lessons learned from analyzing 30 years of patient data in a regional German hospital

Background: The integration of Hospital Information Systems (HIS) into healthcare delivery has significantly enhanced patient care and operational efficiency. Nonetheless, the rapid acceleration of digital transformation has led to a substantial increase in the volume of data managed by these systems. This emphasizes the need for robust mechanisms for data management and quality assurance.Objective: This study addresses data quality issues related to patient identifiers within the Hospital Information System (HIS) of a regional German hospital, focusing on improving the accuracy and consistency of these administrative data entries.Methods: Employing a combination of data analysis and expert interviews, this study reviews and programmatically cleanses a dataset with over 2,000,000 patient data entries extracted from the HIS. The areas of investigation are patient admissions, discharges, and geographical data.Results: The analysis revealed that roughly 25% of the dataset was rendered unusable by errors and inconsistencies. By implementing a thorough data cleansing process, we significantly enhanced the utility of the dataset. In doing so, we identified the primary issues affecting data quality, including ambiguities among similar variables and a gap between the intended and actual use of the system.Conclusion: The findings highlight the critical importance of enhancing data quality in healthcare information systems. This study shows the necessity of a careful review of data extracted from the HIS before it can be reliably utilized for machine learning tasks, thereby rendering the data more usable for both clinical and analytical purposes.

Therapeutic Drug Monitoring for Sirolimus in Children with Vascular Anomalies: What Can We Learn from a Retrospective Study.

Objectives: Sirolimus (SRL), a mammalian target of rapamycin inhibitor, has been widely used to treat patients with vascular anomalies (VAs). The objectives of this study were to summarize the routine blood SRL monitoring data for VAs children, to investigate the factors contributing to the variable blood SRL concentrations and to evaluate the efficacy and safety of SRL therapy. Methods: VAs patients with routine blood SRL monitoring from July 2017 to April 2022 at the Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University were retrospectively collected. Clinical data were obtained from the hospital information system. Results: In total, 67 children (35 females) were enrolled. The therapeutic drug monitoring data showed that the range of measured blood trough concentrations (Ctrough) was 3.6-46.8 ng/mL. At the initial measurements, only 33% of patients were in the target concentration range (10-15 ng/mL). But this proportion became 54% at the last measurements. The whole blood-Ctrough-to-daily dose (Ctrough/Dose) ratio was significantly associated with age and body weight (BW). The patients' laboratory results did not change significantly after SRL treatment. Although the incidence of adverse events was relatively high (44.8%), most of them were mild and tolerable. 70.3% patients had total responses to SRL, whereas 29.7% children exhibited stable disease or progressive disease. No significant differences were found in Ctrough between the total response group and non-response group. Conclusions: This retrospective study revealed a high variability in SRL blood concentrations in Chinese children with VAs. Of note, pediatric patients with older age and a higher BW had a lower Ctrough/Dose ratio. It is a concern whether the range of 10-15 ng/mL is feasible for Chinese children based only on our study. Further studies recruiting more patients are required to redefine the target reference range for children with VAs.

Analysis of Adverse Event Notifications Within the Scope of Patient and Employee Safety: An Example of a Public Hospital

This study aimed to analyze the adverse events reported in a public hospital within the scope of patient and employee safety, to develop studies aimed at learning from errors and to increase the awareness of healthcare professionals and to increase the quality of healthcare service provision. The research was designed as a descriptive, cross-sectional, and retrospective quantitative research design. Data were obtained from the Hospital Information Management System and written records with the data collection form created by the researcher. Data were obtained from the adverse events reported between 01.01.2022 and 30.12.2023. According to the findings of the research; A total of 3447 patient safety adverse event reports were made in 2022, and it was determined that 19 of them were falls, 8 were medication safety, 5 were transfusion safety, and 3415 were laboratory safety. A total of 4788 patient safety adverse event reports were made in 2023, and it was determined that 37 of them were falls, 20 were medication safety, 2 were transfusion safety, and 4729 were laboratory safety. In 2022, a total of 111 employee safety undesirable incidents were reported, of which 59 were sharp-edged injuries, 9 were blood and body fluid splashes, and 45 were legal incidents. In 2023, a total of 120 employee safety undesirable incidents were reported, of which 63 were sharp-edged injuries, 6 were blood and body fluid splashes, and 51 were legal incidents. When the 2022-2023 undesirable incident reports are compared, it is seen that the number of reports has increased over the years, which indicates that a reporting culture has been formed in the institution. As a result of the research; It was determined that the most reported undesirable incidents were laboratory safety and sharp-edged injuries.

Effect of structured individual and combined education on blood glucose regulation in type 2 diabetes mellitus

Abstract Although various approaches have been used in diabetes self-management education (DSME) programs, the effect of DSME programs on glycemic control is controversial. This study aimed to compare the effects of structured individual education and combined education on glycemic regulation in type 2 diabetes mellitus (T2DM). This study included T2DM patients who applied to the Ust Kaynarca Diabetes Center between 1 January 2018 and 11 March 2020. All data were retrospectively evaluated from hospital information systems. Patients who received only individual education were defined as the individual education group (IEG), and patients who received both individual and group education were defined as the combined education group (CEG). A total of 496 T2DM patients, with 248 (50.0%) in the IEG and 248 (50.0%) in the CEG, were included in the study. The change in HbA1c (ΔHbA1c) value for the IEG was 1.0% (2.5%), while the ΔHbA1c value for the CEG was 1.9% (2.8%) (P < 0.001). When factors affecting the glycemic control were evaluated, it was determined that the type of education [odds ratio (OR) = 2.295, P < 0.001], gender (OR = 1.799, P = 0.007), presence of hyperlipidemia (OR = 0.559, P = 0.032) and presence of medications added to treatment (OR = 1.558, P = 0.041) were effective on glycemic control. Combined education, in which individual and group education are conducted together, is more effective than individual education in glucose regulation.

Promoting health information system in guiding decisions for improving performance: an intervention study at the Research Institute of Ophthalmology, Giza, Egypt.

This study aims to design and test a platform of key performance indicators (KPIs) and indices emphasizing achievements and improvement and helping decision-making. An operations research study was designed to analyze data from the Hospital Management Information System (HMIS) from July 2017 to June 2018 at the Research Institute of Ophthalmology (RIO), Giza, Egypt. The HMIS data were submitted to reform covering parameters in service delivery and corresponding indicators and indices. Data were grouped into four themes: human resources and outpatient, inpatient, and surgical operations. A total of 14 performance indicators were deployed to four specific indices and total performance indices and applied to six teams of ophthalmologists at RIO. The decision matrices were deliberated to demonstrate achievements and provide recommendations for subsequent improvements. Throughout 1 year, six teams of ophthalmologists (n = 222) at RIO provided the following services: outpatient (n = 116,043), inpatient (n = 8,081), and surgical operations (n = 9,174). Teams 2, 1, and 6 were the top teams in the total performance index. Team 4 had plunges in the outpatient index, and Team 5 faced limitations in the inpatient index. The study provided a model for upgrading the performance of the management information system (MIS) in health organizations. The KPIs and indices were used not only for documenting successful models of efficient service delivery but also as examples of limitations for further support and interventions.

Trends of Antimicrobial Sensitivity Among Common Isolates in a Tertiary Care Hospital, Rawalpindi

Objective: To evaluate the resistance patterns of frequently found pathogens to different antimicrobial agents, aiding physicians in choosing appropriate treatment strategies for patients within our locality. Materials and Method: This retrospective observational study took place at Pakistan Railway hospital (PRH) Rawalpindi; from January 2021 to December 2021. Data was obtained from the institute's database, the Hospital Information Management System (HIMS). Pathogens were identified in the laboratory through Gram staining and biochemical tests, and their antibiotic sensitivity profiles using disk diffusion method assessed following protocols established by the Clinical & Laboratory Standards Institute. Statistical analysis was conducted using SPSS version 24, and data entry was carried out accordingly. Results: Overall, 1128 positive cultures were reported in study period including urine, pus, HVS, sputum cultures, stool, blood, catheter tip, and others (tissue fluid, wound, and cannula tip etc.). They comprised 32.8 %, 30.9 %, 16.6%, 5.05 %, 3.81%, 3.72 %, 1.15%, 0.70 % and 0.08% of the other specimens respectively. Among the isolates, Escherichia coli revealed 31.4% resistance against one of the third-generation cephalosporin and 8% to imipenem while Klebsiella pneumoniae exhibited 58.7% resistance. Moreover 82% Staphylococcus aureus were resistant to oxacillin, and 6% to vancomycin. Conclusion: Moderate to reduced susceptibility to frequently utilized antimicrobials has been noted across diverse gram-positive and gram-negative species, apart from Penicillin. To address the escalating resistance to carbapenems and cephalosporins, it is essential to establish and enforce rigorous infection control measures.

Patient´s perception of spatial complexity in emergency spaces of a hospital in China: a method for stakeholders to improve design and management

ABSTRACT The focus of medical facility users has shifted from prioritizing epidemic prevention to prioritizing experience after COVID-19, particularly in the emergency department (ED) of a large-scale Chinese hospital. The current visual elements of the emergency department provide a negative perception to the patients who visit the department. The study aims to optimize the ED's spatial design by understanding how visual elements affect patients' perception of spatial complexity. The methodology involved recreating a patient's typical path through the ED using data from the hospital information system (HIS), capturing images at 70 location nodes, and calculating the fractal dimensions of these images using the box-counting method. Visual elements were categorized into eight groups, and their fractal dimensions and proportions within the images were analyzed. A breakpoint graph was developed to track changes in spatial complexity perception as patients move through the ED. Statistical analysis, including correlation and one-way ANOVA, revealed that spatial attributes and lighting conditions significantly impact spatial complexity. From the results, grouping analysis was conducted on the visual elements of the horizontal surfaces, vertical surfaces, ceiling, furniture, and vegetation. Further optimization was proposed. In conclusion, this study highlights the importance of visual elements in emergency spaces, directly influencing users' perception of spatial complexity. The relationship between spatial complexity and fractal dimension is further emphasized. Stakeholders and designers can use the findings of this study as references to make informed decisions to improve the user's experience in the healthcare-built environment.

A Three-Day Prehabilitation Program is Cost-Effective for Preventing Pulmonary Complications after Heart Valve Surgery: A Health Economic Analysis of a Randomized Trial.

While prehabilitation (pre surgical exercise) effectively prevents postoperative pulmonary complications (PPCs), its cost-effectiveness in valve heart disease (VHD) remains unexplored. This study aims to evaluate the cost-effectiveness of a three-day prehabilitation program for reducing PPCs and improving quality adjusted life years (QALYs) in Chinese VHD patients. A cost-effectiveness analysis was conducted alongside a randomized controlled trial featuring concealed allocation, blinded evaluators, and an intention-to-treat analysis. In total, 165 patients scheduled for elective heart valve surgery at West China Hospital were randomized into intervention and control groups. The intervention group participated in a three-day prehabilitation exercise program supervised by a physiotherapist while the control group received only standard preoperative education. Postoperative hospital costs were audited through the Hospital Information System, and the EuroQol five-dimensional questionnaire was used to provide a 12-month estimation of QALY. Cost and effect differences were calculated through the bootstrapping method, with results presented in cost-effectiveness planes, alongside the associated cost-effectiveness acceptability curve (CEAC). All costs were denominated in Chinese Yuan (CNY) at an average exchange rate of 6.73 CNY per US dollar in 2022. There were no statistically significant differences in postoperative hospital costs (8484 versus 9615 CNY, 95% CI -2403 to 140) or in the estimated QALYs (0.909 versus 0.898, 95% CI -0.013 to 0.034) between the intervention and control groups. However, costs for antibiotics (339 versus 667 CNY, 95% CI -605 to -51), nursing (1021 versus 1200 CNY, 95% CI -330 to -28), and electrocardiograph monitoring (685 versus 929 CNY, 95% CI -421 to -67) were significantly lower in the intervention group than in the control group. The CEAC indicated that the prehabilitation program has a 92.6% and 93% probability of being cost-effective in preventing PPCs and improving QALYs without incurring additional costs. While the three-day prehabilitation program did not significantly improve health-related quality of life, it led to a reduction in postoperative hospital resource utilization. Furthermore, it showed a high probability of being cost-effective in both preventing PPCs and improving QALYs in Chinese patients undergoing valve surgery. This trial is registered in the Chinese Clinical Trial Registry (URL: https://www.chictr.org.cn/) with the registration identifier ChiCTR2000039671.

Developing an integrated HIV clinical and population database in rural south Africa

BackgroundHIV cohort data are crucial for understanding the effects of HIV infection and treatment. Linkage between HIV clinical and population records unlocks potential to understand the cause and consequences of social-economic factors on HIV-care seeking behaviors and mortality outcomes. We created HIV data infrastructure by linking HIV treatment records with routinely collected records. MethodsWe linked HIV cohort data(n=119,434) to Health and Demographic Surveillance(n=256,425), laboratory tests(n=617,314), clinic visits and hospital admissions(n=170,325) from KwaZulu-Natal, an HIV-endemic setting in rural South Africa. We used graph-based probabilistic record linkage algorithm to link the data for HIV patients accessing care at 17 clinics within the Hlabisa sub-district. Africa Health Research Institute (AHRI) has collected health and demographic surveillance data since 2000. AHRI has set up a hospital information system in the district to capture ICD-10 code admissions and discharges. ResultsFrom the 5% sample of 462,524 linkage clusters, the computed F-score was 0.88, sensitivity was 88% and positive predictive value was 91%. 38.5% of the patient ID clusters contained records linked across multiple databases. 36% of the HIV patient ID clusters contained records linked with laboratory tests. 19.5% of the HIV patient ID clusters contained data on demographic surveillance. 12.5% of the HIV patient ID clusters contained records linked with clinic visits and hospital admissions. 4% of patient IDs contained records across all four databases. ConclusionWe have successfully created a cross-sectorial HIV cohort through probabilistic record linkage methods. The cohort provides a platform to answer policy-relevant questions.

Timely data on the dynamic drug supply is crucial in addressing the ongoing drug poisoning crisis. The team is exploring ways to share information with emergency responders, healthcare providers, government officials, and pwSUD.

ObjectiveTransitioning from hospitals to primary care brings significant challenges, including increased readmission rates, mortality, and costs due to information gaps. Alberta, Canada, addressed this by integrating 1000+ health systems and implementing Connect Care (CC), a Clinical Information System (CIS), to enhance patient safety and care coordination. In 2020, the Primary Health Care Integration Network (PHCIN) released the Home to Hospital to Home (H2H2H) Transitions Guideline and metrics to improve patient outcomes and system integration. ApproachThis study examines provincial data on H2H2H transitions measures from acute care hospitals using CC between April 1, 2022, and October 31, 2023, to assess transitions and support improvement efforts. CC data assesses transition components, including confirming primary care providers at hospital discharge, utilizing the LACE Readmission Risk Index, and ensuring timely discharge summary (DS) signoffs. It links with administrative data to evaluate post-discharge outcomes like primary care physician follow-up, unplanned readmissions, and Emergency Department (ED) visits. Results47 CC-implemented sites show nearly 80% discharges identified a primary care provider; less than 5% incorporated the LACE index in DS. About 90-93% of DS were signed within 24-72 hours. Approximately 62% of moderate-risk and 55% of high-risk discharges received timely follow-up. Readmission and ED visit rates within 7-30 days varied from 2-8% and 5-11% respectively. ConclusionIn conclusion, adopting CC and H2H2H transition metrics facilitates integrated care measurement, highlighting the need for risk index inclusion and high-risk discharge follow-up for improved patient transitions. Sustained initiatives are vital for optimal outcomes and system integration in Alberta.

Perancangan Sistem Informasi Pengolahan Data Rekam Medis Elektronik Guna Menunjang Tata Kelola Pelaporan Rawat Jalan

Recording and reporting medical records is the main activity in health service institutions, and hospital information systems play an essential role in this process. Outpatient data processing at XYZ Hospital uses spreadsheets and Google Sheets even though it has yet to implement SIMRS fully. Because the data in the SIMRS must be changed for each spreadsheet report, there are several reporting problems. Therefore, the authors begin to develop a web-based outpatient reporting system after researching the need for more efficient applications. This study uses a qualitative approach to data collection through interviews and observations, focusing on developing a waterfall software. The results showed that searching and managing patient data and making outpatient recapitulation reports became easier for medical record officers. Implementing this system brings several concrete impacts, including reducing human errors in data recording, increasing the speed of access to medical information, and increasing time efficiency in making reports. This system also allows better data integration between hospital departments, improving patient care coordination and the overall quality of health services.

Comparing terminology mappings to ICD-10 coded data in Discharge Abstract Database (DAD) in Alberta, Canada

IntroductionCoding has become burdensome to healthcare systems due to patient complexity and resource requirements. In Alberta, Intelligent Medical Objects (IMO), an interface terminology mapping product, is integrated within the new province-wide Clinical Information System, named Connect Care (CC), to support documentation by clinicians and map clinical terminologies to ICD-10. This study evaluates comparability of terminologies mapped ICD-10 codes to the ICD-10 codes in DAD. ApproachWe conducted a retrospective analysis by linking acute care hospital DAD with CC between April 2021 and December 2023. The primary outcome was the level of agreement between ‘hospital problem list’ of CC and DAD for ICD-10-CA codes at a 3-digit level. The number of diagnoses and rate of unspecified codes were also compared. The outcome measures were stratified by physician specialty, hospital type and location, and length-of-stay (LOS). ResultsA total of 498,834 unique hospital records were linked. The average level of agreement between CC and DAD at 3-digit level of ICD-10-CA code was 43.4%. The average number of diagnoses captured in CC (3.91) was slightly lower than DAD (4.06), and the average rate of unspecified codes was higher in CC (26.4%) compared to DAD (23.0%). The level of agreement varied by specialty and length-of-stay with specialties with more complex patients and longer lengths-of-stay having the lowest agreement (43% for generalists and internal medicine and 33% for LOS >3 months). ConclusionLevel of agreement between CC and DAD for ICD-10 data was identified as low, indicating significant disparities between terminology mappings and the coding process.

SP9.10 - The Sarcoma Hub and Spoke Diagnostic Service Can be Safely and Effectively Rolled-Out and Continued

Abstract Aims To understand the safety and effectiveness of the newly established Sarcoma Hub and Spoke Service (SHSS) in detecting malignancies through assessment of the performance of one Spoke Service in triaging lesions of concern. Methods Patients referred to our Diagnostic Service on the 2 week-wait pathway (2WW) and have had their lesion(s) of interest removed between an 18-month period were identified from our Hospital Information System. Data was collected for post-op histology, suspicion of diagnosis in the pre-op MDT, compatibility between the two, and whether patient was cleared from suspicion of malignancy before removal of the lesion. Results 119 patients meeting the criteria were identified. 90 had been cleared of suspicion for malignancy prior to surgery. 83/90 of these had samples sent for histology, yielding 82 benign and 1 malignant (dermatofibrosarcoma protruberans) results. Of the 29 patients who had excision biopsy on the 2WW, 5/29 returned histology for risk of (e.g. possible sarcoma or atypical lipoma) or confirmed malignancies. 46/119 cases were discussed at our SHSS MDT and have both pre-op MDT diagnosis records and histology results; 37/46 of these were compatible – all correctly predicted benign pathologies. Where pre-op MDT diagnosis and histology were incompatible, 1/9 predicted benign diagnosis but returned malignant histology. Conclusion Our SHSS Diagnostic Service’s process of triaging lesions concerning for sarcoma, including our MDT and surgical excision biopsies, is accurate. Preliminary data shows that the Sarcoma Hub and Spoke Service is a safe way to aid in diagnosing or ruling out soft tissue sarcoma.

WP2.1 - New Sarcoma Hub and Spoke Service Can Timely Exclude Malignancy and Effectively Cut Patient Waiting Time for Removal of Benign Lesions

Abstract Aims To assess efficiency of the newly established Sarcoma Hub and Spoke Service (SHSS) through assessment of the length of duration on the Sarcoma 2 week-wait pathway (2WW) and time to surgery for patients already cleared from suspicions of malignancies within one Trust’s Spoke Service. Methods Patients referred to our SHSS on the 2WW who have been cleared from suspicions of malignancies and subsequently underwent removal of lumps/lesions between July 2022 and December 2023 at our Trust were identified from the Hospital Information System. Data is collected on first appointment, time of surgery, as well as time from exclusion of malignancy (Off 2WW) to surgery. Results We identified 119 patients referred to 2WW within the 18-month period, and 90 having had surgery after being taken off 2WW. The median duration from their first appointment to Off 2WW was 37 days (Q1=21d, Q3=61d). The median time from Off 2WW to surgical excision was 132 days (Q1=81d, Q3=202d). Conclusion Given how the ‘traditional’ Sarcoma Pathway at tertiary centres discharges patients cleared from suspicion of malignancies back to GP for them to then refer on on routine pathways to local surgical services, the new SHSS model can investigate and timely exclude malignancies. It is also able to effectively cut waiting time to surgery within the same unit for patients as shown through the acceptable surgery waiting time despite backlog from the recent pandemic and industrial actions. This can also mean decreased workload for both GPs and local General Surgery services.