Victorian Emergency Minimum Dataset Research Articles

Presentation to Emergency Departments due to chemotherapy induced complications: Opportunities for improving service delivery

Advances in oral and systemic chemotherapy have enabled administration of chemotherapy in day oncology or outpatient settings although as chemotherapy regimens have become more aggressive in toxicity the risk of side effects has increased. Patients receiving chemotherapy as out-patients are required manage health issues at home without direct supervision of nursing and medical staff. Given the increased administration of chemotherapy as in outpatient settings, Emergency Departments (EDs) play a key role in the management of patients undergoing chemotherapy. The aim of this study was to conduct an analysis of ED presentations among patients undergoing chemotherapy. A retrospective audit of adult day oncology patients across three Victoria health services was conducted. Information was collected from Victorian Emergency Minimum Dataset and medical records of a random sample of 750 patients who received chemotherapy through day oncology and who presented to ED due to chemotherapy complications in 2007. Health care resources to manage the complication were collected, including all medical interventions, laboratory and microbiological tests, diagnostic imaging procedures, number of specialist visits among hospitalised patients, and number of consultations in relation to the episode. To date, data analysis for 120 patients is complete. Age ranged from 24 to 82 years; 59% were male, 35% were admitted to hospital from ED, and the average ED length of stay was eight hours. The major diagnostic groups were fever/infection (20%), GI symptoms (18%); cardiac (10%); respiratory (6%); CVA (4%); and haematology (3%). The implications of these results in terms of service delivery will be discussed.

Bicycling injuries and mortality in Victoria, 2001–2006

To investigate the incidence of bicycling injuries and bicycle injury characteristics in the Victorian population. Review of prospectively collected data. Bicycling injury data were extracted from four datasets for the period July 2001 to June 2006: (i) emergency department (ED) presentations from the Victorian Emergency Minimum Dataset; (ii) hospital admissions from the Victorian Admitted Episodes Data Set; (iii) major trauma cases from the Victorian State Trauma Registry (VSTR); and (iv) deaths from the National Coroners Information System. The profile and incidence of bicycling injuries across the datasets and years. In the 5 years, 25 920 bicycle-related ED presentations were recorded, 10 552 bicyclists were admitted to hospital, 298 bicycling injuries were classified as major trauma (VSTR), and there were 47 bicycling fatalities. From 2001 to 2006, the incidence of bicycle-related ED presentations (incidence rate ratio [IRR] = 1.42; 95% CI, 1.37-1.48), hospital admissions (IRR = 1.16; 95% CI, 1.09-1.23) and major trauma (IRR = 1.76; 95% CI, 1.22-2.55) increased significantly. Most of those injured were males, aged < 35 years, with road-related injuries. Patients classified as having major trauma had a significantly higher incidence of trunk and head/face/neck injuries compared with those presenting to an ED or admitted to hospital. The incidence of serious bicycling injury has risen over recent years, highlighting the need for targeted prevention programs. Accurate data on cycling participation, use of injury prevention strategies, and injury profiles would assist in reducing bicycle-related injury.

Emergency Department Presentations of Victorian Aboriginal and Torres Strait Islander People

This paper explains how routinely collected data can be used to examine the emergency department attendances of Victorian Aboriginal and Torres Strait Islander people. The data reported in the Victorian Emergency Minimum Dataset (VEMD) for the 2006/2007 financial year were analysed. The presentations of Aboriginal and Torres Strait Islander and non-Aboriginal people were compared in terms of age, gender, hospital location (metropolitan and rural) and presenting condition. Aboriginal and Torres Strait Islander people were found to attend the emergency department 1.8 times more often than non-Aboriginal people. While the emergency department presentation rates of metropolitan Aboriginal and Torres Strait Islander and non-Aboriginal people were similar, rural Aboriginal and Torres Strait Islander people presented to the emergency department 2.3 times more often than non-Aboriginal people. The injuries or poisonings, respiratory conditions and mental disorders presentation rates of the Aboriginal and Torres Strait Islander and non-Aboriginal population were compared. No previous studies have assessed the accuracy of the Indigenous status and diagnosis fields in the VEMD; therefore the quality of this data is unknown.

The increasing problem of motorcycle injuries in children and adolescents

To quantify an anecdotally apparent increase in motorcycle-related injuries in children and adolescents across Victoria. Retrospective analysis of paediatric motorcycle injuries (1 July 2000 - 30 June 2004) from a statewide emergency department (ED) database (Victorian Emergency Minimum Dataset [VEMD]) and the Trauma Registry database at the Royal Children's Hospital (RCH), Melbourne. Trends in paediatric motorcycle-related injuries over time; patient demographics, circumstances of accidents (on or off road), and injury characteristics, including severity markers. The VEMD recorded 3163 patients aged < or = 16 years presenting to EDs with motorcycle injuries during the study period; population-based rates of these injuries increased by an average of 9.6% per year (95% CI, 6.2%-13.1%; P < 0.005). In the same period, there was a total of 167 motorcycle-related admissions to the RCH, increasing annually in line with statewide ED presentations. About a quarter of paediatric motorcycle accidents occurred in children aged under 10 years (VEMD, 22%; RCH, 27%) and most occurred off road (VEMD,89%; RCH, 71%). At the RCH, median length of stay was 3 days (interquartile range [IQR], 1-7 days) and the median Injury Severity Score was 9 (IQR, 4-10); 41% of patients required an operation, 13% were admitted to an intensive care unit, and two died. In Victoria, the incidence of motorcycle-related injuries is increasing in children and adolescents. Most of these injuries occur off road, outside of any legislative framework. There is an urgent need for coordinated legislative changes and educational efforts to decrease motorcycle injuries in children.

The increasing problem of motorcycle injuries in children and adolescents

OBJECTIVE: To quantify an anecdotally apparent increase in motorcycle-related injuries in children and adolescents across Victoria. DESIGN, SETTING AND PARTICIPANTS: Retrospective analysis of paediatric motorcycle injuries (1 July 2000 - 30 June 2004) from a statewide emergency department (ED) database (Victorian Emergency Minimum Dataset [VEMD]) and the Trauma Registry database at the Royal Children's Hospital (RCH), Melbourne. MAIN OUTCOME MEASURES: Trends in paediatric motorcycle-related injuries over time; patient demographics, circumstances of accidents (on or off road), and injury characteristics, including severity markers. RESULTS: The VEMD recorded 3163 patients aged

Predictors of readmission after elective coronary artery bypass graft surgery

We sought to examine potential predictors of readmission after coronary artery bypass graft (CABG) surgery. We analysed routinely collected data of CABG patients who have used the public hospital system of Victoria, Australia from July 1998 to June 2003. In total, 6,627 patients were selected by linking records of elective surgery waiting time data (Elective Surgery Information System), emergency department data (Victorian Emergency Minimum Dataset) and hospital discharge data (Victorian Admitted Episodes Dataset). The outcome measures were 7-day, 30-day and 6-month readmissions. Possible predictors included were age, gender, Charlson comorbidity index, waiting times, length of stay in the hospital, and frequency of emergency department (ED) visits before CABG surgery. 7.1%, 15.2%, and 32.3% of the study population were readmitted at 7 days, 30 days and 6 months respectively. In a multivariable regression model Charlson comorbidity index was associated with 30-day (OR = 1.18; 95% CI 1.11-1.24; P < 0.01) and 6-month readmission (OR = 1.20; 95% CI 1.15-1.26; P < 0.01). Multiple ED visits were associated with 7 day (OR = 1.75; 95% CI 1.28-2.38; P < 0.01), 30 day (OR = 1.53; 95% CI 1.22-1.93; P < 0.01) and 6 month (OR = 1.80; 95% CI 1.49-2.18; P < 0.01) readmission. Waiting time was not a statistically significant predictor of readmission.

Population‐based study of paediatric head injury

There is a paucity of population-based studies regarding the spectrum of paediatric head injury from mild through serious to fatal paediatric head injury. The aims of the present study were to determine the incidence, demographics and outcome of significant head injury in a state-wide population of children aged 0-15 years. A secondary aim was to determine if any serious head injuries were being missed under the current management protocols of the state-wide trauma system. A retrospective review of significant head injury in all paediatric patients over a period of 2 years was undertaken. Data were collected from the Victorian State Trauma Outcome Registry and Monitoring database, the Victorian Emergency Minimum Dataset and from the Victorian Institute of Forensic Medicine. The incidence of paediatric head injury in Victoria over the 2-year period was 765 per 100000 per year. The incidence of admitted head injuries was 75 per 100000 per year and the incidence of significant head injury was seven per 100000 or 151 children. Forty-one per cent of these injuries required surgical intervention. Mortality was 1.6 children per 100000. All patients who died presented with a Glasgow Coma Score (GCS) of 3 and had multiple other risk factors. There were no deaths in patients discharged from hospital. Demographic and clinical factors associated with higher mortality and morbidity was determined. The incidence of significant paediatric head injury was low. Deaths occurred early and were always associated with significant early clinical features of severe head injury. This highlights the importance of strategies for the prevention of head injuries. There appeared to be no serious head injuries missed during the study period.

Animal and human bite injuries in Victoria, 1998–2004

To describe the epidemiology of mammal (human and non-human) bite injuries in Victoria. Retrospective case series of injuries recorded in the Victorian Emergency Minimum Dataset (VEMD) (1998-2004) and deaths recorded in the National Coroners Information System (1 July 2000 - 1 June 2006). Frequency, nature and outcome of injury as a function of mammal, victim demographics and season. Of 12 982 bite injuries identified in the VEMD, dogs, humans, and cats were implicated in 79.6%, 8.7%, and 7.2% of cases, respectively. Dog bite injuries were commonly sustained to the hands/wrists (31.3%) and face/head (25.4%); cat bites to the hands/wrists (67.6%) and arms (16.0%); and human bites to the hands/wrists (37.1%), arms (20.5%) and face/head (20.4%). Males comprised 73.7% and 56.3% of human and dog bite victims, respectively, while females comprised 64.1% of cat bite victims. A third of dog bite victims (33.4%) were children aged 14 years or less. Most human bite victims (79.8%) were adults aged 20-49 years, inclusive. More injuries were sustained on weekends and during the summer, 55.4% of injuries occurred in the home, and 11.6% of patients required hospital admission. Dog bites resulted in three deaths. Mammal bite injuries are common and often require inpatient care. Patterns of bite injuries relate to the type of mammal involved. These epidemiological data will inform prevention initiatives to decrease the incidence of mammal bites.

Ladders revisited

To describe the epidemiology of falls from ladders in a state-wide population. Retrospective review of data from the the Victorian State Trauma Registry and the Victorian Emergency Minimum Dataset on patients presenting to public hospital emergency departments (EDs) with injuries due to a fall while climbing a ladder, from 1 July 2001 to 30 June 2005. Overall trends in the incidence of ladder-related ED presentations, and in cases of major trauma, trends according to age, and trends according to activity at the time of the fall. 4553 patients presented to EDs after falls from ladders in Victoria during the study period; 160 patients had injuries classified as major trauma. There has been a significant rise in the number of presentations to EDs following falls from ladders in Victoria, with a marked increase in the number of cases involving patients aged over 50 years and those climbing ladders outside of paid working conditions. Deaths occurred predominantly in the elderly after falls from heights above 1 metre. Despite knowledge of the dangers of falls from ladders, there has been a significant increase in the number of patients presenting to hospitals after ladder falls. Middle-aged to elderly patients undertaking unpaid work account for this increase. A targeted public health initiative is required to curb this trend.

Victorian Emergency Minimum Dataset: Factors that impact upon the data quality

The Victorian Emergency Minimum Dataset (VEMD) records details of approximately 80% of Victoria's ED presentations. Its usefulness for quality assurance and research relies on the data being both complete and accurate. We aimed to determine the factors that impact adversely on the collection of high-quality VEMD data. The study was a voluntary, anonymous, cross-sectional survey of a range of ED staff (medical, nursing, clerical) who collect and enter data into the VEMD. Nine of the 28 hospitals that contribute to the VEMD were surveyed. The questionnaire was purpose-designed and self-administered. A total of 218 staff participated (response rate 95%). Six different software types were used, with 40% of respondents using the Pickware (MCAT) system. There was no consistency of ED personnel for the completion of specific data fields. One hundred and twenty-six (56%) respondents had heard of the VEMD, 67 (29%) had had its structure and purpose explained and 65 (30%) had been trained to enter data. Ninety-seven (45%) respondents knew what the VEMD data was used for, 38 (17%) knew they could request VEMD data for their own use and 17 (7.8%) had done so. Time constraints, software problems and lack of formal orientation and training in data entry were reported as the most important factors impacting adversely upon quality data entry. Staff knowledge of the VEMD system and its uses are poor. Numerous factors impact on the quality of data entered and interventions aimed at improving staff education, training and feedback and software are indicated.

The use of injury surveillance databases to identify emerging injury hazards

Among the many valuable uses of injury surveillance is the potential to alert health authorities and societies in general to emerging injury trends, facilitating earlier development of prevention measures. Other than road safety, to date, few attempts to forecast injury data have been made, although forecasts have been made of other public health issues. This may in part be due to the complex pattern of variance displayed by injury data. The profile of many injury types displays seasonality and diurnal variance, as well as stochastic variance. The authors undertook development of a simple model to forecast injury into the near term. In recognition of the large numbers of possible predictions, the variable nature of injury profiles and the diversity of dependent variables, it became apparent that manual forecasting was impractical. Therefore, it was decided to evaluate a commercially available forecasting software package for prediction accuracy against actual data for a set of predictions. Injury data for a 4-year period (1996 to 1999) were extracted from the Victorian Emergency Minimum Dataset and were used to develop forecasts for the year 2000, for which data was also held. The forecasts for 2000 were compared to the actual data for 2000 by independent t-tests, and the standard errors of the predictions were modelled by stepwise hierarchical multiple regression using the independent variables of the standard deviation, seasonality, mean monthly frequency and slope of the base data (R = 0.93, R(2) = 0.86, F(3, 27) = 55.2, p < 0.0001). Significant contributions to the model included the SD (beta = 1.60, p < 0.001), mean monthly frequency (beta = -0.72, p < 0.002), and the seasonality of the data (beta = 0.16, p < 0.02). It was concluded that injury data could be reliably forecast and that commercial software was adequate for the task. Variance in the data was found to be the most important determinant of prediction accuracy. Importantly, automated forecasting may provide a vehicle for identifying emerging trends.

Unintentional ingestion of over the counter medications in children less than 5 years old.

Childhood ingestion of medications remains a substantial problem. Medication available over the counter (OTC) is widely used and has significant toxicity. The present study aims to investigate the nature and extent of unintentional ingestion of OTC medication in children < 5 years old in Victoria, Australia, during the period 1996-2000, in order to highlight critical factors. Numbers of enquiries relating to unintentional ingestion of OTC medication in children < 5 years old and medication types were obtained from the Victorian Poisons Information Centre for 1998-2000. Emergency Department presentations involving poisoning of children < 5 years old, the medication types and subsequent admissions were obtained from the Victorian Emergency Minimum Dataset for 1996-2000. Numbers of enquiries and Emergency Department attendances for poisoning were substantially higher for OTC medication than for prescription medication; however, a lower proportion of cases involving ingestion of OTC medication (24.8%) required hospital admission during the study period compared with cases involving ingestion of prescription medications (33.8%). Overall, the peak incidence was at 2 years of age, with a slight male over-representation. Paracetamol and cough/cold preparations were the most common agents. The causes of unintentional ingestion of OTC medications by children might include lack of child-resistant closure (CRC), inadequate design of CRC, attitudes concerning the toxicity of OTC medications, or lack of vigilance by parents and carers in the storage and administration of OTC medications. Consideration should be given to restricting sales of toxic OTC medications to pharmacies, and increasing counselling of consumers concerning the toxicity and safe storage of OTC medications and the correct usage of CRC. The adequacy of CRC design and OTC medications warranting CRC should be reviewed by the relevant authorities.

An Analysis of Marine Animal Injuries Presenting to Emergency Departments in Victoria, Australia

To describe the epidemiology of marine animal injury in Victoria, Australia, in order to identify risk factors and recommend prevention strategies. Retrospective, descriptive study of patients with marine animal injuries who presented to Victorian emergency departments between October 1995 and June 2000. Data were obtained from the Victorian Emergency Minimum Dataset. The main outcome measures were the marine animal involved; the nature, time, and place of injury; and subject demographics and activity. Two hundred five injuries were identified, and males predominated (71.7%, P < .01). Injuries were most frequent during summer and when jellyfish were most prevalent. Various fish species, stingrays, jellyfish, and sharks were incriminated in 83 (40.5%), 46 (22.4%), 42 (20.5%), and 5 (2.4%) injuries, respectively. Most (65.9%) injuries occurred during leisure or sport, and 72 (35.1%) occurred in a place of recreation. Spikes, spines, and barbs caused 82 (40.0%) injuries, and stings caused 54 (26.3%) injuries. Bites were uncommon. Most injuries were to the limbs, with the hands or feet injured in 127 (62.0%) patients. Forty (19.5%) injuries were associated with a retained foreign body. Only 17 (8.3%) patients required admission to the hospital. Marine animal injury is seasonal but rarely serious. Vigilance is required when handling fish, and protective gloves, footwear, and clothing are recommended where appropriate. Clinicians should consider retained foreign bodies in penetrating injuries. Warnings are recommended when jellyfish are most prevalent.

A consensus-based process to define standard national data elements for a canadian emergency department information system

Canadian hospitals gather few emergency department (ED) data, and most cannot track their case mix, care processes, utilization or outcomes. A standard national ED data set would enhance clinical care, quality improvement and research at a local, regional and national level. The Canadian Association of Emergency Physicians, the National Emergency Nurses Affiliation and l'Association des médecins d'urgence du Québec established a joint working group whose objective was to develop a standard national ED data set that meets the information needs of Canadian EDs. The working group reviewed data elements derived from Australia's Victorian Emergency Minimum Dataset, the US Data Elements for Emergency Department Systems document, the Ontario Hospital Emergency Department Working Group data set and the Canadian Institute for Health Information's National Ambulatory Care Reporting System data set. By consensus, the group defined each element as mandatory, preferred or optional, and modified data definitions to increase their relevance to the ED context. The working group identified 69 mandatory elements, 5 preferred elements and 29 optional elements representing demographic, process, clinical and utilization measures. The Canadian Emergency Department Information System data set is a feasible, relevant ED data set developed by emergency physicians and nurses and tailored to the needs of Canadian EDs. If widely adopted, it represents an important step toward a national ED information system that will enable regional, provincial and national comparisons and enhance clinical care, quality improvement and research applications in both rural and urban settings.

Validation of an injury surveillance epidemiological data system used within emergency departments

Objectives To establish ascertainment rates, validity, and the presence of bias within the Victorian Emergency Minimum Data set (VEMD). Methods Experienced researchers conducted interviews using a paper-based instrument to collect injury details. These data were obtained in parallel with the routine electronic collection of injury data within four of the 25 VEMD hospitals. Data were matched using the unique date and time of presentation, as well as birth date. Interviews were conducted with 481 injured persons. Results Electronic and paper records were successfully matched in 382 cases. A high mean capture rate (82.5%) across hospitals was found when the interview data and VEMD data were compared. Data were mostly coded with some inaccuracy, 87% of cases had at least one error, yet when compared with interview descriptions, the coded injury and incident data were usually valid (83.9%). However, narrative data provided information beyond coded data for only 14.1% of cases. Conclusions These results suggest that the VEMD is a reliable and valid computerised data set, but that the case narratives require attention.