Inclusion of patient-level emergency department characteristics to classify potentially redirectable visits to subacute care: a modified Delphi consensus study

Ryan P. Strum; Walter Tavares; Andrew Worster; Lauren E. Griffith; Andrew P. Costa

doi:10.9778/cmajo.20220062

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Table 1:

Demographic characteristics of the expert committee in the modified Delphi consensus exercise

Characteristic	No. (%) n = 16
Sex
Male	12 (75)
Female	4 (25)
Primary medical practice
Emergency medicine	13 (81)
Family medicine	2 (13)
Both	1 (6)
Physician college certification
CCFP	2 (13)
CCFP EM	6 (37)
FRCPC	8 (50)
Length of practice, yr
< 5	2 (13)
5–9	4 (25)
10–14	1 (6)
15–19	2 (13)
20–24	1 (6)
25–29	2 (13)
≥ 30	4 (25)
Medical director, Ontario paramedic practices	5 (31)

Note: CCFP = Certification in the College of Family Physicians, CCFP EM = Certification in the College of Family Physicians, with Competence in Emergency Medicine, FRCPC = Fellow of The Royal College of Physicians of Canada.

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Table 2:

Results of a 2-round modified Delphi exercise to establish which patient characteristics are important to consider when classifying whether an emergency department visit was primary care–like and potentially redirectable to subacute care centres by paramedics

Characteristic	Round 1, no. (%)^*		Round 2, no. (%)^*^†		Consensus	Specification of parameters from expert committee^‡

	Yes	No	Yes	No
Age, yr	13 (81)	3 (19)	–	–	Useful	Lowest age: 18 (n = 13)^¶ Highest age: 50 (n = 1), 55 (n = 1), 65 (n = 1), 70 (n = 5),^** 75 (n = 3), no upper limit (n = 2)

Sex	0 (0)	16 (100)	–	–	Not useful	Not useful to include and/or specify

Triage acuity, CTAS	16 (100)	0 (0)	–	–	Useful	Lowest acuity: CTAS level 5 (n = 16)^¶ Highest acuity: CTAS level 4 (n = 12),^** CTAS level 3 (n = 6)

Main diagnostic category, ICD-10^§	9 (56)	7 (44)	10 (67)	5 (33)	No consensus	Consensus was not reached among the Delphi committee

Comorbidities	4 (25)	12 (75)	–	–	Not useful	Not useful to include and/or specify

Specialist consult performed in ED	15 (94)	1 (6)	–	–	Useful	Include only visits that did not receive a specialist consult in the ED (n = 15)

Outcome of ED visit	13 (81)	3 (19)	–	–	Useful	Discharged from ED (n = 13) Admitted to hospital (n = 1) Transfer to another acute care facility directly from ED (n = 1) Left after triage, no medical assessment (n = 6)

Time from triage to ED outcome	2 (12)	14 (88)	–	–	Not useful	Not useful to include and/or specify

Return to ED within ≤ 30 d	7 (44)	9 (56)	3 (20)	12 (80)	Not useful	Not useful to include and/or specify

Note: CTAS = Canadian Triage and Acuity Scale, ED = emergency department, ICD-10 = International Statistical Classification of Diseases and Related Health Problems, 10th Revision.
↵* Consensus set at 75% agreement of all experts.
↵† Fifteen of the 16 experts participated in Round 2.
↵‡ Only experts who answered “Yes” to the consensus question were included to specify parameters.
↵§ Category did not receive consensus after Round 2.
↵¶ Indicates the lower bound of a characteristic parameter.
↵** Indicates the upper bound of a characteristic parameter.