Urgency Related Groups (URGs)

see also:

• funding of Emergency Departments in Australia
• Australian Refined Diagnosis Related Groups (AR-DRGs)

• URG's form a main component of the ED funding model for Australian ED's as of 1 July 2012
• Urgency Disposition Groups (UDG) and Urgency Related Groups (URG) classification system developed in 1992 by Dr. George Jelinek (FACEM)

• there are 2 variables:
  • triage category
    • this is the FIRST recorded triage category - not the final assigned category!
  • 4 dispositions:
    • non-admitted
    • admitted
    • dead on arrival
    • did not wait
    • transfers to another hospital are classed as non-admitted (potentially creating funding issues for hospitals which have high transfer rates)
    • died in ED is classed as admitted
    • left after treatment started is classed as non-admitted
• there are 12 groups:
  1. admitted triage 1
  2. admitted triage 2
  3. admitted triage 3
  4. admitted triage 4
  5. admitted triage 5
  6. non-admitted triage 1
  7. non-admitted triage 2
  8. non-admitted triage 3
  9. non-admitted triage 4
  10. non-admitted triage 5
  11. dead on arrival
  12. did not wait

• URG's are an expansion of UDG's and each map to a parent UDG
• there are 3 variables:
  • triage category
  • disposition
  • principal ED diagnosis grouped into 27 Major Diagnostic Blocks:
    • 1A Poisoning, comatose
    • 1B Poisoning, conscious
    • 1C Drug reaction
    • 1D Alcohol/drug abuse and alcohol/drug induced mental disorders
    • 2A Injury, multiple sites
    • 2B Injury, single site
    • 2BA Injury, single site *minor (subset of MDB 2B)
    • 3A Circulatory system illness
    • 3B Respiratory system illness
    • 3C Digestive system illness
    • 3D Urological illness
    • 3E Neurological illness
    • 3F Illness of the eyes
    • 3G Illness of the ENT
    • 3H Musculoskeletal/connective tissue illness
    • 3I Illness of the skin, subcutaneous tissue, breast
    • 3J Blood/immune system illness
    • 3K Obstetric illness
    • 3L Gynaecological illness
    • 3M Male reproductive system illness
    • 3N System infection/parasites
    • 3O Illness of other or unknown systems
    • 3P Newborn/Neonate
    • 3Q Hepatobiliary system illness
    • 4 Psychiatric illness
    • 5 Social problem
    • 6 Other presentation
• there are 73 groups, for example:
  • UDG 1:
    • URG 1 = admitted triage 1 with MDB 2A
    • URG 2 = admitted triage 1 with MDB 3O
    • URG 3 = admitted triage 1 with MDB 2B
    • URG 4 = admitted triage 1 with MDB 1A/1B
    • URG 5 = admitted triage 1 with MDB 3B
    • URG 6 = admitted triage 1 with MDB 3A
    • URG 7 = admitted triage 1 with MDB other
  • UDG 2:
    • URG 9 = admitted triage 2 with MDB 1A/1B
    • URG 10 = admitted triage 2 with MDB 2A/2B/2BA
    • etc
  • UDG 11 = URG 38 = DOA
  • UDG 12 = URG 73 = DNW

• URG Technical specification v1.3
• URG Diagnosis to MDB mapping table (VEMD 2012-13 Library file) requires DoH password - contact HDSS.HelpDesk@health.vic.gov.au for this
• URG Descriptions/Schema

• no funding model is without flaws
• patients with the same triage category can incur a highly variable range of costs to the hospital, for example, the following would be given a triage 1:
  • heroin overdose receives naloxone and self-discharges within 30 minutes of arrival = non-admitted triage 1
  • STEMI heart attack patient who is rapidly assessed in ED and taken straight to cath lab for admission = admitted triage 1
  • patient requiring intubation, central lines, arterial lines and critical care in ED for many hours awaiting an ICU in another hospital = non-admitted triage 1 !
• a UDG model could potentially favor major tertiary hospitals at the expense of those hospitals without critical care services, without sub-specialties, or those who have lower admission rates such as paediatric ED's.