Median Admit Decision Time to ED Departure Time for Admitted Patients
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| Measure Information | 2022 Reporting Period | 2023 Reporting Period |
|---|---|---|
| Title | Median Admit Decision Time to ED Departure Time for Admitted Patients | Median Admit Decision Time to ED Departure Time for Admitted Patients |
| CMS eCQM ID | CMS111v10 | CMS111v11 |
| Short Name |
ED-2 |
ED-2 |
| CBE ID* | Not Applicable | Not Applicable |
| Measure Steward | Centers for Medicare & Medicaid Services (CMS) | Centers for Medicare & Medicaid Services (CMS) |
| Description |
Median time (in minutes) from admit decision time to time of departure from the emergency department for emergency department patients admitted to inpatient status |
Median time (in minutes) from admit decision time to time of departure from the emergency department (ED) for emergency department patients admitted to inpatient status |
| Measure Scoring | Continuous Variable measure | Continuous Variable measure |
| Measure Type | Process | Process |
| Stratification | *See CMS111v10.html | *See CMS111v11.html |
| Risk Adjustment | *See CMS111v10.html | *See CMS111v11.html |
| Rationale | *See CMS111v10.html | *See CMS111v11.html |
| Clinical Recommendation Statement | *See CMS111v10.html | *See CMS111v11.html |
| Improvement Notation |
Improvement noted as a decrease in the median value |
Improvement noted as a decrease in the median value |
| Definition | *See CMS111v10.html | *See CMS111v11.html |
| Guidance |
This measure specification delineates how to calculate the duration from the Decision to Admit to the departure from an Emergency Department (ED) visit. Decision to Admit: Documentation of the decision to admit the patient from the ED that is closest to the inpatient admission and since admission processes vary at different hospitals this can use either of the following: 1. An Order- A) admission order (this may be an operational order rather than the hospital admission to inpatient status order), B) disposition order (must explicitly state to admit), C) documented bed request, or D) documented acceptance from admitting physician. This is not the "bed assignment time" or "report called time". Or 2. An Assessment- an ED evaluation that results in a decision to "Admit Inpatient" The decision to admit inpatient must be performed during the ED visit that is within 1 hour of the inpatient admission and prior to the patient departing the ED. The specification provides elements from the clinical electronic record required to calculate the median time, i.e., the duration from the decision to admit to the time the patient physically departed the ED. Patients with behavioral health emergencies are stratified because often these situations are confounded by policies and practices in the community that are beyond the control of any individual hospital and present the hospital with quality and safety circumstances different from those of the acute medical patients (Joint Commission, 2012). Recent peer-reviewed studies also demonstrate the need for dedicated emergency mental health services, supplying evidence that the clinical needs for these patients substantively differ from the non-psychiatric population (American College of Emergency Physicians (ACEP), 2017; Lester, 2018). This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM. |
This measure specification delineates how to calculate the duration from the Decision to Admit to the departure from an Emergency Department (ED) visit. Decision to Admit: Documentation of the decision to admit the patient from the ED that is closest to the inpatient admission and since admission processes vary at different hospitals this can use either of the following: 1. An Order- A) admission order (this may be an operational order rather than the hospital admission to inpatient status order), B) disposition order (must explicitly state to admit), C) documented bed request, or D) documented acceptance from admitting physician. This is not the "bed assignment time" or "report called time". Or 2. An Assessment- an ED evaluation that results in a decision to "Admit Inpatient" The decision to admit inpatient must be performed during the ED visit that is within one hour of the inpatient admission and prior to the patient departing the ED. The specification provides elements from the clinical electronic record required to calculate the median time, i.e., the duration from the decision to admit to the time the patient physically departed the ED. Patients with behavioral health emergencies are stratified because often these situations are confounded by policies and practices in the community that are beyond the control of any individual hospital and present the hospital with quality and safety circumstances different from those of the acute medical patients (Joint Commission, 2012). Recent peer-reviewed studies also demonstrate the need for dedicated emergency mental health services, supplying evidence that the clinical needs for these patients substantively differ from the non-psychiatric population (American College of Emergency Physicians (ACEP), 2017; Lester, 2018). The measure population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
| Initial Population |
Inpatient hospitalizations ending during the measurement period with length of stay less than or equal to 120 days, where the patient received services during the preceding emergency department (ED) visit at the facility when a decision to admit inpatient was made prior to departing the ED |
Inpatient hospitalizations ending during the measurement period with length of stay less than or equal to 120 days, where the patient received services during the preceding emergency department (ED) visit at the facility when a decision to admit inpatient was made prior to departing the ED |
| Measure Population |
Initial Population |
Initial Population |
| Next Version | No Version Available | |
| Previous Version | No Version Available |
Additional Resources for CMS111v10
Header
Updated the eCQM version number.
Measure Section: eCQM Version Number
Source of Change: Annual Update
Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Revised and updated the rationale section to include recent citations.
Measure Section: Rationale
Source of Change: Measure Lead
Revised and updated the clinical recommendation section to include recent citations.
Measure Section: Clinical Recommendation Statement
Source of Change: Measure Lead
Updated references.
Measure Section: Reference
Source of Change: Annual Update
Added clarifying language to the guidance section of episode-based measures to define the episode.
Measure Section: Guidance
Source of Change: Measure Lead
Added guidance to explain why the measure stratification includes psychiatric/mental health populations.
Measure Section: Guidance
Source of Change: Measure Lead
Logic
Shortened the names of AdmitDecisionUsingAssessmentDuringLastEDBeforeDeparture and admitDecisionUsingEncounterOrderDuringLastEDandBeforeDepartureto AdmitDecisionUsingAssessment and AdmitDecisionUsingEncounterOrder to improve readability.
Measure Section: Initial Population
Source of Change: Annual Update
Added a 'let' clause AdmitAssessment: 'AdmitDecisionUsingAssessmentDuringLastEDBeforeDeparture'(EncounterInpatient) to streamline the text used to express the logic in the NormalizeInterval function in the ED Encounter with Decision to Admit definition.
Measure Section: Initial Population
Source of Change: Annual Update
Removed the word 'from' and added parentheses to group logic to ensure intent is captured in the ED Encounter with Decision to Admit definition.
Measure Section: Definitions
Source of Change: Annual Update
Updated Global.'Inpatient Encounter' definition by adding 'day of' to ensure all cases within the measurement period are captured and evaluated in the initial population.
Measure Section: Definitions
Source of Change: Measure Lead
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.
Measure Section: Definitions
Source of Change: Standards Update
Added new NormalizeInterval function to timing attributes to decrease implementation burden due to variable use of timing attributes for select QDM data types. The NormalizeInterval function was applied, where applicable, for the following data elements: Assessment, Performed; Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Laboratory Test, Performed; Medication, Administered; Medication, Dispensed; Physical Exam, Performed; Procedure, Performed; Substance, Administered.
Measure Section: Functions
Source of Change: Standards Update
Corrected the spelling of the word 'occurred' within the inline comment of the function AdmitDecisionUsingEncounterOrderDuringLastEDandBeforeDeparture.
Measure Section: Functions
Source of Change: Measure Lead
Relocated the 'EDEvaluation.result' in 'Admit Inpatient' clause in the logic to improve calculation efficency and added starts to the timing to ensure intent is captured in the AdmitDecisionUsingAssessment function.
Measure Section: Functions
Source of Change: Annual Update
Revised the approach for identifying the location period end date by adding the Global.'HasEnd' function. The Global.'HasEnd' function more clearly and consistently identifies when the Emergency Department Visit location period interval has an end date.
Measure Section: Functions
Source of Change: Standards Update
Value Set
The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.
Value set Decision to Admit to Hospital Inpatient (2.16.840.1.113883.3.117.1.7.1.295): Added 1 SNOMED CT code (432661000124104) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Psychiatric/Mental Health Diagnosis (2.16.840.1.113883.3.117.1.7.1.299): Added 2 SNOMED CT codes (160822004, 817962007) based on terminology update. Deleted 8 SNOMED CT codes (106013002, 111476001, 191539009, 192118006, 229729009, 231475006, 28857002, 82096005) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Admit Inpatient (2.16.840.1.113762.1.4.1111.164): Deleted 6 SNOMED CT codes (183767005, 183768000, 183783005, 183789009, 185970004, 185971000) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead