Integrity of Data Collection in Emergency Departments

P60 V3

This policy of the Australasian College for Emergency Medicine (ACEM; the College) relates to the integrity of data collection within emergency departments (EDs). Data collected to measure activity and performance is essential to inform policy and planning decisions. It must be accurate and comprehensive to be an effective tool for analysis and improvement. This Policy is applicable to EDs in Australia and Aotearoa New Zealand.

1. Key performance indicators are used as quantifiable measures to evaluate the efficiency and quality of a health service and to inform policy and planning decisions. ACEM supports the use of uniform measures across the hospital system to ensure the integrity of data.
2. Time-based targets are beneficial to patient care and the overall patient journey by providing important information to drive improvements across the healthcare system. ACEM recommends that all Governments adopt ACEM’s Hospital Access Targets.[1]
3. The intentional misrepresentation or ‘gaming’ of performance management data to achieve good/ improved scores on service metrics is unacceptable.^[2]
4. Systematic non-collection of data or purposeful omission of data undermines data integrity and is unacceptable.
5. ACEM believes all Fellows have a moral and professional responsibility to ensure that data generated in the ED is a true and accurate representation of their service.
6. Accurate data collection has the potential to:

• • Promote transparency and accountability in reporting clinical activity and performance;
  • Enhance the safety and efficiency of emergency care by informing resource planning and service delivery;
  • Inform continuous quality improvement and research; and
  • Strengthen advocacy efforts through the provision of credible, reliable and data driven insights on the allocation of resources and patient outcomes.

       Lack of data integrity has the potential to:

• • Misrepresent service performance and obscure risks to patient safety and staff wellbeing;
  • Obscure the real relationship between ED demand, the allocation of resources and patient outcomes;
  • Undermine the scientific validity of ED research; and
  • Inaccurately represent the effect(s) of process change within a department or hospital, and/or conceal potential avenues for process improvement.

The ACEM Policy on Standard Terminology (P02) provides recommended specifications for certain time measured components of a patient’s interaction with the ED, including arrival time and departure (‘physically leaves’) time.

7. ACEM believes that all ED staff should be educated on the importance of data integrity. The ACEM Curriculum Framework specifies that emergency physicians who have attained Fellowship will be able to analyse and review data obtained for key performance indicators, use data on patient flow in the ED to improve patient care, and make recommendations based on results obtained for key performance indicators.
8. ACEM acknowledges that retrospective data entry is sometimes necessary. The medical record will inform this data entry. The accuracy of data entry should therefore be independently verifiable in the medical record should an audit be undertaken.
9. ACEM promotes the adoption of automated, real-time data systems that streamline information capture, reduce the significant administrative burden on clinicians and enhances the coordination and safety of patient care.
10. Optimal care of individual patients in the ED will always be prioritised above departmental performance measures.

3. Responsibilities of ACEM and its Members

1. All College members and trainees must maintain the integrity of data collection and presentation relating to their ED. For Fellows in particular this includes advocating at an organisational level to maintain the objectivity and accuracy of ED data.
2. In situations where there is evidence of intentional misrepresentation of ED data by a College member or trainee, or ED staff member, that individual will be referred by the College to the relevant health service and/or state and/ or federal authorities for further investigation in accordance with the relevant legislation.
3. Any College member or trainee found to have intentionally misrepresented ED data may be subject to disciplinary proceedings pursuant to the provisions of the ACEM Constitution and associated College regulations and processes.
4. ACEM recognises that achievement of time-based performance targets involves processes within and external to the ED, including factors and systems outside of ED control. Achieving targets involving external factors should therefore be a hospital-wide responsibility, not solely an ED management responsibility.
5. ACEM will support members who are subject to undue pressure and/or sanctions regarding performance targets when factors outside of ED control prevent the expected outcome.