The Power of Emergency Department Classifications – Risk Stratification Analytics Part 2
Emergency departments are our nation’s back-up plan, intercepting urgent conditions of all types and intervening to stabilize and regain health. Emergency departments found their place in our health care system to provide decisive, rapid care to patients with life-threatening conditions.
Today, too many patients seek care in the emergency department for non-life altering reasons. 25% of all visits, a heavy price tag of $4.4 billion dollars, can been prevented. Understanding why patients seek care for non-urgent needs in this setting is vital to controlling costs and improving health outcomes.
Johns Hopkins ACG® System Emergency Department Algorithm utilized by KPI Ninja equips you with the knowledge you need to better meet your patients’ needs. Based on encounter and diagnosis information, emergency room visits can be classified into one of eleven categories.
Patients with conditions that are associated with a greater probability of hospitalization
Here are some examples of diagnoses, using ICD-10 CM codes, that fall into the avoidable classifications:
Non-Emergent
- J02.9 Acute Pharyngitis
- J06.9 Acute Upper Respiratory Infection
- N39.0 Urinary Tract Infection
- R11.2 Nausea with Vomiting
- R51 Headache
Emergent, Primary Care Treatable
- B34.9 Viral Infection
- J18.9 Pneumonia
- J20.9 Acute Bronchitis
- R10.9 Unspecified Abdominal Pain
- R10.13 Epigastric Pain
As you can witness, this is an expanded version of the original New York University Emergency Department Algorithm. The primary difference is that this algorithm assesses a larger set of diagnosis codes and encounters. It can classify each visit into one of eleven categories rather than using probabilistic assignment and can provide greater clarity around injury visits with categorizing into three different severity levels.
It takes a lot of understanding and planning as well as rethinking about what we believe is important for patients to live a healthy life, but when you unlock the power of analytics, you give providers the ability to see health care in new and profound ways. Keeping patients out of the emergency department should be a priority for all providers and visit classification is one of the best type of analytics that not only reveals opportunities but provides convincing information about how health care needs to change.
Reference
Weinick R. M., Burns R.M., & Mehrotra A. Many emergency department visits could be managed at urgent care centers and retail clinics. Health Affairs. 2010;29(9):1630–1636.
About the Author
Renee Towne
VP of Population Health at KPI Ninja, Inc.
Renee provides operational leadership of quality initiatives at KPI Ninja. Towne has a background in occupational therapy, education and experience in operational excellence across a variety of healthcare domains. Based on prior experience as a clinician that drove outcomes patient by patient, she is leaving a larger footprint by improving health care more comprehensively, population by population.
About KPI Ninja
KPI Ninja is a data analytics company that helps healthcare organizations accelerate their quality, safety, and financial goals with a unique combination of software and service. We are differentiated by our signature mix of technology, performance management consulting and healthcare expertise. We don’t merely offer software solutions but work shoulder to shoulder with clients to help them draw on the power of analytics and continuous improvement methodologies to become more efficient. In harmony with our data-centered ethos, we truly believe that our success is strongly co-related with yours.