NACRS Emergency Department (ED) Visits: Volumes and Median Length of Stay by Triage Level, Visit Disposition, and Main Problem

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Quick Stats Metadata

Emergency Department (ED) Visits: Volumes and Median Length of Stay

Highlights for these Quick Stats are available, by fiscal year, at:
https://secure.cihi.ca/estore/productSeries.htm?pc=PCC526
.

Metadata for the reports follows the template below:

Name of Report

General description of the report of interest.

Data Source(s)

Database(s) from which the data for the report of interest is derived.

Available Statistics

Figures available in the report of interest (for example, number of visits, length of stay).

Available Breakdowns

All possible methods by which the data for the report of interest may be grouped (for example, by sex, by five-year age groups).

Inclusions

Characteristics of records included in the data for the report of interest.

Exclusions

Characteristics of records excluded from the data for the report of interest.

Methodology

Analytical approach used to calculate the figures presented in the report of interest.

Important Notes

Additional information that is relevant to the report of interest (for example, coverage in a particular fiscal year).

Contact Details

Where to go to get more information on these reports.

Name of Report

Emergency Department (ED) Visits: Volumes and Median Length of Stay

Data Source(s)

National Ambulatory Care Reporting System (NACRS), Canadian Institute for Health Information (CIHI)

Available Statistics

  • Number of ED Visits
  • Median Length of Stay (Minutes)

Available Breakdowns

  • Fiscal Year of Visit, Based on Registration Date
    • 2003–2004 to 2011–2012
  • Triage Level
    • Total, resuscitation, emergent, urgent, less-urgent, non-urgent, unknown
  • Visit Disposition
    • Total, discharged home or to place of residence, not seen or left, admitted, transferred, death, intra-facility transfer, unknown
  • Main Problem
    • Any, acute myocardial infarction (AMI), asthma, pneumonia, influenzal pneumonia, trauma, motor vehicle collisions (MVC), unintentional falls
  • Sex
    • All, male, female
  • 5- and 20-Year Age Groups

Inclusions

  • ED visits from participating facilities in Prince Edward Island, Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia and Yukon are included.
    • ED visits are defined by the Management Information Systems (MIS) Functional Centre Account Code Series = 7*310 or Amcare_group code = ED (as of 2010–2011).
  • Canadian and non-Canadian residents receiving care in participating Canadian EDs are included.
  • Records with invalid length of stay are included in the number of ED visits.
  • Records with unknown triage level are included in the number of ED visits.
  • Records where sex is categorized as “other” are included in the “all” sex counts.
  • Records where birth date is unknown are included in the “total” age counts.

Exclusions

  • Visits from non-participating ED facilities are excluded.
  • Scheduled ED visits are excluded.
    • Scheduled ED visit indicator = ”Y” or ED visit indicator = “0” (as of 2011–2012).
  • Records with invalid length of stay are excluded from the median length of stay calculation.
  • Duplicate records were identified using all data elements except the following: am_care_key, abstract_id_number and date_recorded.

Methodology

  1. Triage Level: The five levels of triage for ED visits were developed by the Canadian Association of Emergency Physicians (CAEP) with definitions according to the Canadian Emergency Department Triage and Acuity Scale (CTAS).
  • Resuscitation (Triage Level = 1): Conditions that are threats to life or limb (or imminent risk of deterioration) requiring immediate aggressive interventions.
  • Emergent (Triage Level = 2): Conditions that are a potential threat to life, limb or function, requiring rapid medical intervention or delegated acts.
  • Urgent (Triage Level = 3): Conditions that could potentially progress to a serious problem requiring emergency intervention. May be associated with significant discomfort or affecting ability to function at work or activities of daily living.
  • Less urgent (Triage Level = 4): Conditions that are related to a patient’s age, distress or potential for deterioration or complications that would benefit from intervention or reassurance within one to two hours.
  • Non-urgent (Triage Level = 5): Conditions that may be acute but non-urgent as well as conditions that may be part of a chronic problem, with or without evidence of deterioration. The investigation of or interventions for some of these illnesses or injuries could be delayed or even referred to other areas of the hospital or health care system.
  • Unknown (Triage Level = 9 or blank): Occurs when triage level is not documented or patient leaves before triage (Visit Disposition = 02).
  • Visit Disposition: Visit Disposition (VD) refers to one of the following types of separation from the ED as defined by CIHI–NACRS (refer to the NACRS Manual for specific VD legend):
    • Discharged to home or to place of residence: VD = 01 or 15. Note: VD 15 was introduced in 2005–2006; therefore, for previous fiscal years, only VD 01 was included for this group.
    • Left without being seen/left against medical advice (not seen or left) (includes left prior to triage, further assessment, treatment or treatment completed): VD = 02, 03, 04 or 05.
    • Admitted (includes admitted to reporting facility to both ICU/operating room or another unit): VD = 06 or 07.
    • Transferred (includes transferred to another acute or non-acute care facility): VD = 08 or 09.
    • Death (includes death in ED or death on arrival): VD = 10 or 11.
    • Intra-facility transfer (includes intra-facility transfer to surgical day/night care or clinic): VD = 12, 13 or 14.
  • Main Problem:
    • Acute Myocardial Infarction (AMI): ED visit record with any of the following ICD-10-CA codes documented as the Main Problem:
      • Versions 2003 and 2006: I21 or I22
      • Version 2007 patch and version 2009: I21, I22, R94.30 or R94.31
    • Pneumonia: ED visit record with any of the following ICD-10-CA codes documented as the Main Problem:
    1. Versions 2003 and 2006: A481, J120, J121, J122, J128, J129, J13, J14, J150, J151, J152, J153, J154, J155, J156, J157, J158, J159, J160, J168, J180, J181, J182, J188, J189 or J851
    2. Version 2009: A481, J120, J121, J122, J128, J129, J13, J14, J150, J151, J152, J153, J154, J155, J156, J157, J158, J159, J160, J168, J180, J181, J182, J188, J189, J851 or J123
  • Influenzal Pneumonia*: ED visit record with any of the following ICD-10-CA codes documented as the Main Problem:
    1. Version 2003: J10.0 or J11.0
    2. Version 2006 and 2009: J09, J10.0 or J11.0
  • Asthma: ED visit record with the following ICD-10-CA code documented as the Main Problem:
    • Versions 2003, 2006 and 2009: J45
  • Trauma: ED visit record (excluding those where Main Problem equals AMI, pneumonia, influenzal pneumonia or asthma) with any of the following ICD-10-CA codes documented as one of the Other Problems:
    • Version 2003: V01–V99, W00–W19, W20–W45, W49–W60, W64–W70, W73–W77, W81, W83–W94, W99, X00–X06, X08–X19, X30–X39, X50, X52, X58, X59, X70–X84, X86, X91–X99, Y00–Y05, Y07–Y09, Y20–Y34 or Y35–Y36
    • Version 2006 and 2009: V01–V99, W00–W19, W20–W45, W46, W49–W60, W64–W70, W73–W77, W81, W83–W94, W99, X00–X06, X08–X19, X30–X39, X50, X52, X58, X59, X70–X84, X86, X91–X99, Y00–Y05, Y07–Y09, Y20–Y34 or Y35–Y36
  • Motor Vehicle Collisions (MVC): ED visit record (excluding those with Main Problem equal to AMI, pneumonia, influenzal pneumonia or asthma) with any of the following ICD-10-CA codes documented as one of the Other Problems:
    • Versions 2003, 2006 and 2009: V01–V99
  • Unintentional Falls: ED visit record (excluding those with Main Problem equal to AMI, pneumonia, influenzal pneumonia or asthma) with any of the following ICD-10-CA codes documented as one of the Other Problems:
    • Versions 2003, 2006 and 2009: W00–W19

    Notes
    * The counts of influenzal pneumonia were not included in the counts of pneumonia.
    MVC and Unintentional Falls are subsets of the Trauma category. Other transport accidents (such as water, air and space transport accidents) were included in the MVC category as well; however, these accounted for less than 2% of MVC-related ED visits.

    1. Age: Registration Date minus Date of Birth
    2. Number of ED Visits: All records meeting the above inclusion and exclusion criteria
    3. Median Length of Stay (LOS):
      As of 2010–2011, LOS = minus .
    • If Visit Disposition = 02, use Registration Date/Time; otherwise, use whichever is earlier: Triage Date/Time or Registration Date/Time.
    • If Visit Disposition = 06, 07, 08, 09, 12, 13 or 14, use Patient Left ED Date/Time if known; otherwise, use Disposition Date/Time.
    • If Visit Disposition = 01, 02, 03, 04, 05, 10, 11 or 15, use Disposition Date/Time if known; otherwise, use Patient Left ED Date/Time.

      From 2008–2009 to 2009–2010, LOS = minus .

      • If Visit Disposition = 02, use Registration Date/Time; otherwise, use whichever is earlier: Triage Date/Time or Registration Date/Time.
      • If Visit Disposition = 06, 07, 08 or 09, use Patient Left ED Date/Time if known; otherwise, use Disposition Date/Time.
      • If Visit Disposition = 01, 02, 03, 04, 05, 10, 11, 12, 13, 14 or 15, use Disposition Date/Time if known; otherwise, use Patient Left ED Date/Time.

      For 2007–2008, LOS = minus .

      • If Visit Disposition = 02, use Registration Date/Time; otherwise, use whichever is earlier: Triage Date/Time or Registration Date/Time.
      • If Visit Disposition = 06, 07, 08 or 09, use Patient Left ED Date/Time if known; otherwise, use Disposition Date/Time.
      • If Visit Disposition = 01, 02, 03, 04, 05, 10, 11, 12, 13, 14 or 15, use Disposition Date/Time.

      From 2003–2004 to 2006–2007, LOS =
      minus .

      • If Visit Disposition = 02, use Registration Date/Time; otherwise, use whichever is earlier: Triage Date/Time or Registration Date/Time.

    Important Notes

    • While CIHI applies rigorous edit checks to NACRS data and provides coder training and vendor support, CIHI ultimately relies on submitting facilities to ensure that their data accurately and completely reflects the true patient ambulatory activity in those facilities.
    • The number of facilities that submitted ED visit data to NACRS varied between 2003–2004 and 2011–2012. Due to this variation, trending across fiscal years is not recommended. Users are advised to refer to the NACRS Data Quality documents for more details. Tables that present 2010–2011 and 2011–2012 NACRS Emergency Department visits by province (Alberta, Ontario and other provinces, which includes Prince Edward Island, Nova Scotia, Manitoba, Saskatchewan, British Columbia (for 2011–2012 only) and Yukon), sex and five-year age groups are available on CIHI’s website (www.cihi.ca). Click on “Quick Stats,” select “Pre-Formatted Table” under type and “Hospital Care” under “Topic” and then select the NACRS statistics. These statistics reflect the number of visits, which does not necessarily equal the number of individuals.
    • In 2003–2004, 2004–2005 and 2008–2009, some facilities reported a disproportionately high number of ED visit records (greater than 10%) coded as Visit Disposition 05 (left before medical treatment completed). These records were included in the number of ED visits but were excluded from the valid Visit Disposition count.
    • For 2003–2004, 2004–2005 and 2005–2006, Length of Stay (LOS) for ED visits may be overestimated for some facilities due to the difficulty of collecting the exact time the visit was completed. When the exact time the visit is completed is not available, some vendor systems and abstractors may use 2359 as a proxy value.
    • LOS in the ED might not be comparable across historical fiscal years due to newly added and/or retired time elements related to the calculation of LOS in the ED; in 2007–2008, four data elements (Decision to Admit Date/Time and Date/Time Visit Completed) were deleted from NACRS because it was not possible to calculate key indicators. Four new data elements (Disposition Date/Time and Date/Time Patient Left ED) were introduced in NACRS in 2007–2008 so that key indicators, such as time waiting for an inpatient bed, could be calculated.

    Contact Details

    For information on the National Ambulatory Care Reporting System, please visit /CIHI-ext-portal/internet/en/document/types+of+care/hospital+care/emergency+care or send an email to cad@cihi.ca.

    For assistance using interactive CIHI data, please send an email to help@cihi.ca.

    All other inquiries can be sent to

    Canadian Institute for Health Information
    495 Richmond Road, Suite 600
    Ottawa, Ontario K2A 4H6
    Telephone: 613-241-7860
    Fax: 613-241-8120

    Use CIHI's accessibility request form to request CIHI documentation in an accessible format.