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

Last updated: September 14, 2018

CMS Measure ID: CMS32v8
Version: 8
NQF Number: 0496
Measure Description:

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

Initial Patient Population:

Emergency department encounters during the measurement period

Measure Population:

Initial Populationinfo-icon and prevents null values from being included in the median calculation

Measure Observations:

Median elapsed time (in minutes) from emergency department arrival to emergency room departure or for patients placed in observation services, use the time of the order for observation for ED departure for patients discharged from the emergency department

Measure Steward: Centers for Medicare & Medicaid Services (CMS)
Short Name: ED-3
Previous Version:
Improvement Notation:

Improvement noted as a decrease in the median value

Guidance:

This measure uses a continuous variableinfo-icon. The specificationinfo-icon 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 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 variable 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 Description.

    Measure Section: Description

    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

  • Updated Measure Observations for ED patients placed in observation services, to use the time of the observation order for ED Departure time to better align with the chart-abstraction version of the measure.

    Measure Section: Measure Observations

    Source of Change: Measure Lead

  • Updated Measure Population for emergency department encounters.

    Measure Section: Measure Population

    Source of Change: Measure Lead

Logic

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

    Measure Section: Denominator Exclusionsinfo-icon

    Source of Change: Standards Update

  • Added 'code' attribute to all datatypes to conform with QDM 5.3 changes.

    Measure Section: Measure Population Exclusions

    Source of Change: Standards Update

  • 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

  • Added logic to the Measure Observation for ED patients placed in observation services, to use the time of the observation order for ED Departure time to determine the Median elapsed time (in minutes) from emergency department arrival to ED departure. This logic change better aligns with the chart-abstraction version of the measure.

    Measure Section: Measure Observations

    Source of Change: Measure Lead

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

    Measure Section: Stratification

    Source of Change: Measure Lead

  • 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

  • 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 Observation Services (2.16.840.1.113762.1.4.1111.143): Added Observation Services that contains revised ED departure time for ED patients placed in observation services.

    Measure Section: QDM Data Elements

    Source of Change: Chart Abstracted Measures

  • Replaced SNOMEDCT single code value sets with direct referenced codes. A direct referenced code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct referenced codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct referenced codes.

    Measure Section: QDM Data Elements

    Source of Change: Standards 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