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Median Admit Decision Time to ED Departure Time for Admitted Patients

Last updated: September 14, 2018

CMS Measure ID: CMS111v7
Version: 7
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:

Initial Populationinfo-icon

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 & Medicaid Services (CMS)
Short Name: ED-2
Previous Version:
Improvement Notation:

Improvement noted as a decrease in the median value

Guidance:

This measure specificationinfo-icon 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 stratificationinfo-icon and then with each stratum applied. For this measure, the number of encounters that fall into the Initial Populationinfo-icon 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 variableinfo-icon defined by the Measure Observation is reported for the Measure Population also, then reported according to the defined stratification.

Meaningful Measure: Patient’s Experience of Care

Specifications

Release Notes

Header

  • Updated Version Number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Replaced the word Stratum with Stratificationinfo-icon to align with CQLinfo-icon MATinfo-icon export.

    Measure Section: Stratification

    Source of Change: Measure Lead

  • Added 'resulting in an inpatient stay' to the Measure Population Exclusion to clarify intent of the measure and better align with the logic.

    Measure Section: Measure Population Exclusions

    Source of Change: Measure Lead

Logic

  • Removed 'Transfer from' datatype to conform with QDMinfo-icon 5.3 changes.

    Measure Section: Denominator Exclusionsinfo-icon

    Source of Change: Standards Update

  • Replaced 'Discharge status' attribute with 'Discharge Disposition' attribute for 'Encounter, Performed' and 'Transfer From' with 'Admission Source' for 'Encounter, Performed' datatypes to align with QDM 5.3 changes.

    Measure Section: Denominator Exclusions

    Source of Change: Standards Update

  • Replaced <= 6 hours timing constraint with logic that ties the 'admissionSource' (transfer from) to the Inpatient Encounter and the ED Encounter visit because the timing constraint is not required with CQL.

    Measure Section: Measure Population Exclusions

    Source of Change: Measure Lead

  • Modeled the Location attribute for Encounter, Performed to allow for describing the patient’s presence in a single location during an individual Encounter to conform with QDM 5.3 changes.

    Measure Section: Measure Observations

    Source of Change: Standards Update

  • Replaced the word Stratum with Stratification to align with CQL MAT export.

    Measure Section: Stratification

    Source of Change: Measure Lead

  • Added supplemental timing attributes to most datatypes in QDM 5.3 to facilitate accurate retrieval of time related information within CQL logic. Timing attributes now include a time interval, such as prevalence period or relevant period, and/or actual time of documentation with Author Datetime. Relevant period is the general method to describe start and stop times for datatypes. Prevalence period is used for some datatypes to more accurately define onset and abatement times.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Assigned cardinality to each attribute to be more explicit in guiding specificationinfo-icon and implementation of QDM data elements. Cardinality refers to the number of instances of the attribute that can be included in the measure description. Cardinality for most attributes is 0.. 1 (i.e., can occur up to 1 time), but some attributes have a cardinality of 0.. * (i.e., can occur multiple times).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • CQL libraries contain sets of CQL definitions, or CQL expression statements. A context statement, patient or population, can now be used in a CQL library to clearly establish how the subsequent list of CQL expressions will be interpreted. A 'Population' context will interpret the CQL expression with reference to the entire population of the item being counted, patients or encounters. A 'Patient' context will interpret the CQL expression with reference to a single patient. Context statements are not required, but one or more context statements may be used within a library to help clarify how the CQL expressions will be interpreted. Patient context is the default if none is specified.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Replaced measure-defined definitions with similar definitions and functions from CQL shared libraries for consistency across measures.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated measure logic from Quality Data Model (QDM)-based logic to Clinical Quality Language (CQL)-based logic. Information on CQL can be found at the eCQI Resource centerinfo-icon (https://ecqi.healthit.gov/cql). Information about specific versions of the new standards in use for CMS reporting periods can be found at the eCQI Resource Center (https://ecqi.healthit.gov/ecqm-tools-key-resources). Switching from QDM to CQL brings with it many changes, as well as enhanced expression capability, but only those changes with significant impact will be outlined in technical release notes. For example, in the case of timing operators, changes may only be summarized if those changes impact the measure calculation.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Setinfo-icon

The VSACinfo-icon is the source of truth for the value set content, please visit the VSAC for downloads of current value setsinfo-icon.

  • Value set (2.16.840.1.113883.3.117.1.7.1.299): Renamed to Psychiatric/Mental Health Diagnosis.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Psychiatric/Mental Health Diagnosis (2.16.840.1.113883.3.117.1.7.1.299): Deleted 5 SNOMEDCT codes (191536002, 191537006, 191540006, 1938002, 230290000).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 11 SOP codes (299, 32127, 32128, 391, 517, 524, 614, 621, 622, 623, 629) and deleted 3 SOP codes (63, 64, 69).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Deleted 1 SOP code (24).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Psychiatric/Mental Health Diagnosis (2.16.840.1.113883.3.117.1.7.1.299): Added 6 ICD10CM codes (F12.23, F12.93, F53.0, F68.A, Z62.813, Z91.42) and deleted 1 ICD10CM code (F53). Deleted 5 SNOMEDCT codes (191601008, 191602001, 191606003, 268620009, 79578000).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

External Resources