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Objectives: Prediction of pediatric emergency department (PED) workload can allow for optimized allocation of resources to improve patient care and reduce physician burnout. A measure of PED workload is thus required, but to date no variable has been consistently used or could be validated against for this purpose. Billing codes, a variable assigned by physicians to reflect the complexity of medical decision making, have the potential to be a proxy measure of PED workload but must be assessed for reliability. In this study, we investigated how reliably billing codes are assigned by PED physicians, and factors that affect the inter-rater reliability of billing code assignment. Methods: A retrospective cross-sectional study was completed to determine the reliability of billing code assigned by physicians (n = 150) at a quaternary-level PED between January 2018 and December 2018. Clinical visit information was extracted from health records and presented to a billing auditor, who independently assigned a billing code–considered as the criterion standard. Inter-rater reliability was calculated to assess agreement between the physician-assigned versus billing auditor-assigned billing codes. Unadjusted and adjusted logistic regression models were used to assess the association between covariables of interest and inter-rater reliability. Results: Overall, we found substantial inter-rater reliability (AC2 0.72 [95% CI 0.64–0.8]) between the billing codes assigned by physicians compared to those assigned by the billing auditor. Adjusted logistic regression models controlling for Pediatric Canadian Triage and Acuity scores, disposition, and time of day suggest that clinical trainee involvement is significantly associated with increased inter-rater reliability. Conclusions: Our work identified that there is substantial agreement between PED physician and a billing auditor assigned billing codes, and thus are reliably assigned by PED physicians. This is a crucial step in validating billing codes as a potential proxy measure of pediatric emergency physician workload. [ABSTRACT FROM AUTHOR]

Background: Achieving diversity, inclusion, and gender equity remains an elusive challenge for many institutions worldwide and is understudied in Canadian academic health science centres., Methods: McMaster University's Department of Medicine undertook surveys and analyses to determine whether there was inequity in leadership positions and salaries, or unprofessional behaviour within the department. Measures of academic productivity in relation to gender for both educators and researchers were analyzed. The department began shifting policies to foster greater gender diversity and inclusion. A revision of the leadership selection process, incorporating tenets of equity and a new game theory-based strategy called Diversitive Agreement Versus Nash Equilibrium (DAvNE) was evaluated., Results: The department's survey revealed underrepresentation of women and people of colour in leadership positions, with perceived barriers to their promotion. Both women and people of colour reported experiencing unprofessional behaviour directed toward them. A gender gap in base salary was observed, with female full professors being paid less. No difference in academic productivity was seen between male and female educators or researchers. The leadership competitions conducted under new selection processes emphasizing diversity resulted in 66% of participating women securing a leadership position, in comparison to 25% of participating men. People of colour made up 27% of members participating in these leadership competitions, but none was successful in obtaining a position., Conclusions: Diversity and inclusion disparities in the Department of Medicine at McMaster University indicate a need for further efforts and innovation to bring about greater gender and racial equity., (© 2021 The Authors.)