Managing an emergency department by analysing HIS medical data: a focus on elderly patient clinical pathways.

INTRODUCTION: The objective of this paper is to present complementary views of the activity of the emergency department for a specific group of patients. Once validated, these views will be used as decision support tools for better managing the department and providing better care delivery for this population. The views are produced from the data stored in Healthcare Information Systems that correspond potentially to a vast source of information for supporting decisions on management or public health issues. METHOD: The study focuses on two groups of patients: the elderly population (over 75-years-old) and the under 75-year-old patients, at the Rennes hospital. The validation of the views is performed by comparing results for the two distinct groups. Relevant data were extracted from the Emergency Department database. Several analysis (like cusum chart) and representation tools (Graphviz) were used to study the patients' pathways, the dynamics of arrivals and the patients' characteristics. RESULTS: The representations provided a synthetic, global and comprehensive view of the department activities, to the satisfaction of the clinicians. The study showed that ICD-10 coding, assigned at the patient's departure from the emergency department hence from all available known clinical data, is not appropriate for the elderly population as these patients are mainly diagnosed by "symptoms" and several solutions are proposed. Finally, it is stressed out that a proper delivery of care to elderly patients should require some level of scheduling in the emergency department that is by essence characterized by its non scheduled activity.

Towards a decision support system for optimising clinical pathways of elderly patients in an emergency department.

UNLABELLED: Data stored in Healthcare Information Systems correspond potentially to a vast source of information for supporting decisions in management or public health issues. The presented study illustrates clinical data valuation, through the analysis of clinical pathways of elderly patients at the Emergency Department (ED) of Rennes hospital. METHOD: Relevant data were extracted from the Emergency Department database. Several analysis (e.g., cusum method) and representation tools (e.g., Graphviz) were used to study the patients' pathways, the dynamics of flows and the patients' characteristics. RESULTS: 4951 admissions were analysed and visualized. The representations provided a synthetic, global and comprehensive view of the department activities, to the satisfaction of the clinicians. Limitations of the ICD-10 coding of the diagnoses at the ED were pointed out as well as syntax and semantic interoperability issues. A solution is proposed for automating and scaling the Decision Support System.