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CEM Minimum Dataset
Click here to download the current version of the CEM minimum dataset (Published 21 December 2012)
The CEM minimum dataset has been formulated to meet the needs of the various end-users who require data about Emergency Department attendances.
This information is based on international standards where appropriate.
The sustained growth in the volume and complexity of Emergency Care as a result of a number of social and demographic changes have highlighted a gap in the level of information being captured within Emergency Care.
A large increase in workload (numbers and complexity) has occurred. Due to poor quality information, we do not know why this increase has occurred. Many factors may be responsible:
- Social factors such as increased mobility, increasing expectations regarding level of access and level of service have tended to favour ED visits over GP attendances, particularly outside office hours (OOH).
- Demographic factors such as an increasing age have increased the complexity of cases presenting to the Emergency Department.
- Political factors such as the restructuring of GP OOH care, the European Working Time Directive and reduced inpatient beds have forced hospitals to concentrate limited resources where they are most effective: at the front of the hospital in the Emergency Department.
- Technical advances have allowed rapid diagnosis and turnaround within the Emergency Department of patients with conditions that would have historically required hospital admission e.g. chest pain, thromboembolism, cellulitis.
Why do we need better information?
To an Emergency Physician, the Emergency Department is primarily a diagnosis machine. The treatments we do are generally fairly simple, cheap and effective. We may feel that Emergency Department clinicians generally work harder than those in other specialties, but cannot demonstrate this.
To a General Practitioner, Emergency Departments appear to spend a lot of money doing expensive unnecessary tests to make a ‘simple’ diagnosis. The results of this process are communicated poorly, if at all.
To a purchaser of healthcare (PCT, GP consortium), one diagnosis machine (Emergency Department) looks very much like another (GP, ECP, Nurse Practitioner, Walk-In Centre).
To a healthcare policymaker, Emergency Medicine looks very expensive to run because it does lots of tests on its patients, the alternatives do not. Hence the misapprehension that putting GPs in Emergency Departments will reduce the cost of healthcare.
Emergency physicians know that the reason Emergency Departments need to do lots of tests is that just by turning up to an Emergency Department, the pre-test probability of a patient being significantly unwell is much higher than in General Practice. A GP will acutely admit about 1% of all patients seen, whereas an Emergency Department will admit 20-30%. They are very different populations because the prevalence of disease is much higher in the Emergency Department, and therefore the testing strategy needs to be different.
While those of us who work in Emergency Medicine know the extraordinary value for money that the public achieves from its Emergency Departments, the only way Emergency Medicine can demonstrate its worth is by measuring what comes in (inputs) and what goes out (outputs).