BACKGROUND: The Indiana State Department of Health (ISDH) requires, by state law, the electronic submission of chief complaint from patient visits to emergency departments (ED) for syndromic surveillance. While not required, discharge diagnosis can be used to better evaluate the need for public health intervention before medical diagnosis and laboratory results. We evaluate the data quality factors of chief complaint and discharge diagnosis completeness and timeliness prior to updating the reporting requirements.
METHODS: Unique ED visits from all reporting facilities were received for a single day, November 28, 2016, and updates were monitored for 14 days, through December 12, 2016. The total number of messages containing a chief complaint and discharge diagnosis, by facility, were counted and monitored daily for message updates. A chief complaint was considered complete unless it contained only “X”, “NA”, “.”, or “incorrect OBX”. Discharge diagnosis completeness was evaluated by the proportion of messages with at least one International Classification of Disease code.
RESULTS: On November 28, 2016, 10,089 ED visits were reported from 122 facilities with 36,150 messages sent during the 14 day monitoring period. Of 122 facilities, 114 (93%) sent chief complaint for more than 90% of visits; 83 (68%) sent 100% of visits. During the monitoring period, 56 chief complaints were updated during this time frame. Within 24 hours of initial chief complaint submission, 62 (51%) facilities submitted at least a single discharge diagnosis with 40 (33%) facilities sending ≥50% of visits with a discharge diagnosis. After seven days, 76 (62%) facilities submitted at least a single discharge diagnosis with 49 (40%) facilities sending ≥50% of visits with a discharge diagnosis. After 14 days, 81 (66%) facilities had at least a single discharge diagnosis, with 53 (43%) facilities sending ≥50% of visits with a discharge diagnosis.
CONCLUSIONS: During the monitoring period, a majority of facilities sent chief complaint data, but were not as complete when reporting discharge diagnosis. This could be attributed to reporting requirements in state law, when facilities add discharge diagnosis in their system, or submission of working versus final diagnosis. Timely receipt of chief complaint can help identify conditions of public health concern. Including discharge diagnosis in our syndromic surveillance might be helpful when evaluating public health concerns, but only if received in a timely manner. Nearly half of facilities have the ability to report discharge diagnosis, which should minimize the impact of adding it as required reporting.