Median Admit Decision Time to ED Departure Time for Admitted Patients

Last updated: May 17, 2016

CMS Measure ID: CMS111v4
Version: 4
NQF Number: 0497
Measure Description:

Median time (in minutes) from admit decision time to time of discharge from the emergency department for emergency department patients admitted to inpatient status.

Initial Patient Population:

Inpatient Encounters ending during the measurement period with Length of Stay (Discharge Date minus Admission Date) less than or equal to 120 days.

Measure Population:

Inpatient Encounters where the decision to admit was made during the preceding emergency department visit.

Measure Observations:

Time (in minutes) from Decision to Admit to ED discharge for patients admitted to the facility from the emergency department.

Denominator Statement:

Not Applicable

Denominator Exclusions:

Not Applicable

Numerator Statement:

Not Applicable

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Not Applicable

Measure Steward: Centers for Medicare & Medicaid Services
Domain: Person and Caregiver-Centered Experience Outcomes
Short Name: ED2
Next Version: Median Admit Decision Time to ED Departure Time for Admitted Patients
Previous Version: Median Admit Decision Time to ED Departure Time for Admitted Patients
Measure Score: Continuous Variable
Improvement Notation:

Improvement noted as a decrease in the median value

Guidance:

This measure specification defines how to determine the duration from a Decision to Admit and the discharge from an Emergency Department stay. Reporting requires the median of all admit decision to ED discharge durations defined as [Encounter: encounter ED]. decision to admit date and time minus [Encounter: encounter ED]. ED admit decision date and time.

Calculate the ED time in minutes for each person in the measure population; report the median time for all calculations performed. The specification provides elements from the clinical electronic record required to calculate for each ED encounter, i.e., the length of time the patient was in the Emergency Department from the time of decision to admit, also stated as: the Datetime difference for the Emergency Department discharge time minus the Decision to Admit Time. The calculation requires the median across all ED encounter durations.

For each population, results should be reported without stratification and then with each stratum applied. For this measure, the number of encounters that fall into the Initial Population are reported without stratification, then reported according to the defined stratification. The number of encounters that fall into the Measure Population are reported without stratification, then reported according to the defined stratification. The computed continuous variable defined by the Measure Observation is reported for the Measure Population also, then reported according to the defined stratification.

Specifications

Release Notes

Header

  • Clarified that the Initial Population consists of the inpatient encounters ending during the measurement period with length of stay (Discharge DateTime minus Admission DateTime) less than or equal to 120 days.
  • Copyright updated.
  • Disclaimer updated.
  • eMeasure version number incremented.
  • For each population, results should be reported without stratification and then with each stratum applied. For this measure, the number of encounters that fall into the Initial Population are reported without stratification, then reported according to the defined stratification. The number of encounters that fall into the Measure Population are reported without stratification, then reported according to the defined stratification. The computed continuous variable defined by the Measure Observation is reported for the Measure Population also, then reported according to the defined stratification.
  • Reporting stratum modified to include the use of principal diagnoses.
  • Stratification 1 in the prior version of the measure was removed because it was redundant with the measure population. Strata have been renumbered to reflect this update.
  • The rate aggregation description was clarified to explain that measure observation is made on the duration the patient was in the Emergency Department after the decision to admit, also stated as: the Datetime difference between the Emergency Department discharge time and the Decision to Admit time.
  • Updated Measure Population narrative in the header to align with logic.

Logic

  • ED encounter admission and discharge timestamps are used instead of facility location (ED) departure time for timing comparison logic.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions and/or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced variable $EncounterInpatient to allow re-use of logical expressions and reduce redundancy/complexity.
  • Replaced DateDiff or TimeDiff functions with Datetime difference in the measure observation section, and removed 'AND' operators from the statements underneath the DateTimeDiff function.
  • The Measure Population has been clarified. It includes emergency department visits where an inpatient encounter did not start within 119 minutes of the discharge from the emergency department. Use of <= 1 (hour(s)) operator means the difference between the end of the Emergency Department visit and the beginning of the Inpatient visit needs to be less than or equal 1 hour which spans from 0 to 119 minutes and 59 seconds.
  • Replaced timing relationship 'starts before end of' with 'starts before or concurrent with end of' to ensure the inclusion of the end point of the element on the right-hand side of the criterion.
  • Timing operator 'ends before start of' replaced with 'ends before or concurrent with start of' in criteria relating Emergency Department Visit with Inpatient Encounter.This allows for cases in which the ED discharge and inpatient admission occur in the same minute to evaluate to true.

Value Sets

  • Decision to Admit to Hospital Inpatient Grouping Value Set (OID 2.16.840.1.113883.3.117.1.7.1.295): Updated value Set concepts and added 1 SNOMED code (76464004).
  • Psychiatric/Mental Health Patient Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.299): Deleted 21 SNOMED codes and 52 ICD10CM codes, and added 75 SNOMED codes.
  • The concept for 'Hospital Admission for observation' (76464004) was added to this SNOMED value set. The addition of this concept extends the type of admit decisions considered by the measure, but does not affect the timing requirements in the measure's logic.

External Resources