Median Admit Decision Time to ED Departure Time for Admitted Patients

Last updated: October 25, 2017

CMS Measure ID: CMS111v6
Version: 6
NQF Number: 0497
Measure 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.

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, and where the decision to admit was made during the preceding emergency department visit at the same physical facility

Measure Population:

Equals initial population

Measure Observations:

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

Measure Steward: Centers for Medicare and Medicaid Services (CMS)
Short Name: ED2
Previous Version: Median Admit Decision Time to ED Departure Time for Admitted Patients
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 departure from an Emergency Department stay. Reporting requires the median of all admit decision to ED departure durations defined as [Encounter: encounter ED] facility location departure date and time minus [Encounter: encounter ED] ED admit decision date and time.

Decision to Admit: First documentation of the decision to admit the patient from the ED. Specification: as admission processes vary at different hospitals, this can use the first documented time of any of the following: 1) admission order (this may be an operational order rather than the hospital admission to inpatient status order), 2) disposition order (must explicitly state to admit), 3) documented bed request, or 4) documented acceptance from admitting physician. This is not the bed assignment time or report called time.

Calculate the ED time in minutes for each patient 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 facility location departure date/time minus the Decision to Admit date/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.

Addendum Notes: Value Set content updated Sept 2017

Specifications

Release Notes

Header

  • Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • ​Replaced 'discharge' with 'departure' to align with logic to align with logic.

    Measure Section: Description

    Source of Change: Measure Lead

  • ​Replaced 'discharge' with 'departure' to align with logic to align with logic.

    Measure Section: Rate Aggregation

    Source of Change: Measure Lead

  • ​Replaced 'discharge' with 'departure' to align with logic to align with logic.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Added Decision to Admit explanation to provide further guidance.

    Measure Section: Guidance

    Source of Change: JIRA (QRDA-385)

  • Replaced the word 'person' with 'patient' to make sentence more specific.

    Measure Section: Guidance

    Source of Change: Measure Lead

Logic

  • Added 'starts during Occurrence A of Encounter, Performed: Emergency Department Visit and starts before start of Occurrence A of Encounter Performed: Emergency Department Visit (facility location departure datetime)' logic to minimize the gap between the chart abstracted ED measure and the eCQM. Since admission processes vary and the intent is to capture the first documentation of the decision to admit, the additional logic will now capture a decision to admit the patient during the ED encounter or before physically departing the ED.

    Measure Section: Initial Population

    Source of Change: JIRA (QRDA-385)

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): Added 5 SNOMEDCT codes (247444006, 288511000119108, 596004, 715924009, 72366004) to align with the ICD10CM codes and deleted 2 SNOMEDCT codes (229714007, 88339003).

    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): Deleted 2 SNOMEDCT codes (231457005, 231535000). Added 10 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

External Resources