Median Time from ED Arrival to ED Departure for Discharged ED Patients

Last updated: May 3, 2018

CMS Measure ID: CMS32v6
Version: 6
NQF Number: 0496
Measure Description:

Median elapsed time from emergency department arrival to emergency room departure for patients discharged from the emergency department

Initial Patient Population:

Emergency department encounters during the measurement period

Measure Population:

Equals initial population

Measure Observations:

Median elapsed time (in minutes) from emergency department arrival to emergency room departure for patients discharged from the emergency department

Measure Steward: Centers for Medicare and Medicaid Services (CMS)
Domain: Communication and Care Coordination
Short Name: ED3
Next Version:
Previous Version:
Improvement Notation:

Improvement noted as a decrease in the median value

Guidance:

This measure uses a continuous variable. 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, also stated as: the Emergency Department departure time minus the Emergency Department arrival time. The calculation requires the median of all ED encounter durations. This measure specification defines how to determine an individual Emergency Department stay. Reporting requires the median of all patient stays ([Encounter: encounter ED].facility location departure date and time minus [Encounter: encounter ED].facility location arrival date and time).

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.

The measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan - Mar, Q2 = Apr - Jun, Q3 = Jul - Sep, Q4 is Oct - Dec.

Notes: Value Set content updated, Jan 2017 and Sept 2017

Specifications

Release Notes

Header

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Replaced emergency department visit attribute:(admission datetime) with (facility location arrival datetime) and (discharge datetime) to (facility location departure datetime) to use timestamps that reflect the arrival and departure date and times for the Emergency Department visit.

    Measure Section: Guidance

    Source of Change: JIRA (CQM-1645)

  • Modified the language for the description of the Initial Population to more accurately reflect the timing logic.

    Measure Section: Initial Population

    Source of Change: JIRA (CQM-1623)

  • Revised description to include same facility to clarify intent.

    Measure Section: Measure Population Exclusion

    Source of Change: JIRA (CQM-1499)

  • Revised Stratum 3 narrative to specifically state this includes patients who do not have a principal diagnosis consistent with mental disorders and who are not transferred.

    Measure Section: Stratification

    Source of Change: QDM Standards

Logic

  • Replaced operator 'Datetime difference of' with 'Datetimediff' to align with the name of the QDM function.

    Measure Section: Measure Observations

    Source of Change: QDM Standards

  • Removed Emergency Department visit <=6 hour(s) before or concurrent with the start of Inpatient Encounter from Measure Population logic to better align with the measure intent.

    Measure Section: Measure Population

    Source of Change: Annual Update

  • Added logic to exclude patients with an Emergency Department visit <=1 hour(s) before or concurrent with the start of the Inpatient Encounter in order to meet the intent of the measure.

    Measure Section: Measure Population Exclusions

    Source of Change: Annual Update

  • Added new attribute 'principal diagnosis' to 'Encounter, performed' datatype to conform to QDM 4.2 changes and provide more accurate logic. Removed QDM data element Attribute: 'Ordinality: Principal' using 'Principal SNOMEDCT Value Set (2.16.840.1.113883.3.1.7.1.14.)’ to conform to QDM 4.2. changes and provide more accurate logic.

    Measure Section: QDM Data Elements

    Source of Change: QDM Standards

  • Added 'Occurrence A of' to the Emergency Department Encounter and replaced the AND NOT Union of with AND NOT starting each line of logic.

    Measure Section: Stratification

    Source of Change: QDM Standards

  • Replaced 'Diagnosis, Active: XXX (ordinality: Principal)' datatype with 'Encounter, Performed: XXX (principal diagnosis: XXX)' datatype to conform with QDM 4.2 changes and provide more accurate logic.

    Measure Section: Stratification

    Source of Change: QDM Standards

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 Psychiatric/Mental Health Patient (2.16.840.1.113883.3.117.1.7.1.299): Deleted 477 ICD9CM codes. Added 15 SNOMEDCT codes and deleted 1 SNOMEDCT code (426041005). Added 121 ICD10CM codes and deleted 23 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Psychiatric/Mental Health Patient (2.16.840.1.113883.3.117.1.7.1.299): Added 13 ICD10CM codes and deleted 4 ICD10CM codes (F32.8, F34.8, F42, F50.8).

    Measure Section: QDM Data Elements

    Source of Change: ICD-10 Addendum

  • Value set Psychiatric/Mental Health Patient (2.16.840.1.113883.3.117.1.7.1.299): Added 5 SNOMEDCT codes (247444006, 288511000119108, 596004, 715924009, 72366004) and deleted 4 SNOMEDCT codes (229714007, 231457005, 231535000, 88339003). Added 10 ICD10CM codes (F10.11, F11.11, F12.11, F13.11, F14.11, F15.11, F16.11, F18.11, F19.11, F50.82).

    Measure Section: QDM Data Elements

    Source of Change: 4Q 2017 Addendum

External Resources