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Prevalence of information gaps in the emergency department and the effect on patient outcomes

From the Clinical Epidemiology Unit, Ottawa Health Research Institute (A. Steill, van Walraven); the Department of Medicine (Forster, van Walraven) and the Division of Emergency Medicine (I.G. Stiell), University of Ottawa, Ottawa, Ont.; and the Institute for Clinical Evaluative Sciences (van Walraven), Toronto, Toronto, Ont.

Correspondence to: Dr. Carl van Walraven, Clinical Epidemiology Unit, The Ottawa Hospital — Civic Campus, Rm. F660, 1053 Carling Ave., Ottawa ON K1Y 4E9; fax 613 761-5351; carlv{at}ohri.ca

Background: Information gaps occur when previously collected information is unavailable to a physician who is currently treating a patient. In this study we measured the prevalence of physician-reported information gaps for patients presenting to an emergency department at a teaching hospital.

Methods: For 1002 visits to the emergency department made by 983 patients, we recorded all information gaps identified by the emergency physician immediately after the patient was assessed. When an information gap was present, the physician was asked to identify the required information, why it was required and how important it was to the patient's care. We reviewed the patient charts to measure severity of illness and to determine whether the patient was referred to the emergency department by a community physician. Multiple linear regression analysis was used to determine whether information gaps were associated with length of stay in the emergency department.

Results: At least 1 information gap was identified in 323 (32.2%) of the 1002 visits (95% confidence interval 29.4%–35.2%). Information gaps were associated with severity of illness, being significantly more common in patients who had serious chronic illnesses, those who arrived by ambulance, those who had visited the emergency department or had been in hospital recently, patients in monitored areas in the emergency department and older patients. Information gaps most commonly comprised medical history (58%) and laboratory test results (23.3%) and were felt to be essential to patient care in 47.8% of the cases. The presence of information gaps was not associated with admission to hospital. After adjusting for important confounders, including patient sex, previous hospital admissions, diagnosis and severity of illness, we found that stays in the emergency department were 1.2 hours longer on average for patients with an information gap than for those without one.

Interpretation: Information gaps were present in almost one-third of the visits to our emergency department. They were more common in sicker patients and were independently associated with a prolonged stay in the emergency department.

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