Median Admit Decision Time to ED Departure Time for Admitted Patients

Last updated: May 5, 2017

CMS Measure ID: CMS111v5
Version: 5
NQF Number: 0497
Measure Description:

Median time (in minutes) from admit decision time to time of discharge 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 & Medicaid Services (CMS)
Domain: Person and Caregiver-Centered Experience Outcomes
Short Name: ED2
Next Version: Median Admit Decision Time to ED Departure Time for Admitted Patients
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 discharge from an Emergency Department stay. Reporting requires the median of all admit decision to ED discharge durations defined as [Encounter: encounter ED] facility location departure date and time minus [Encounter: encounter ED] ED admit decision date and time.

Calculate the ED time in minutes for each person 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: ICD-10 Value Set addition

Specifications

Release Notes

Header

  • Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: 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.

    Section: Guidance

    Source: JIRA (CQM-1645)

  • Clarified Initial Population by adding Inpatient Encounters preceded by an emergency department visit (at the same physical facility) to meet measures intent.

    Section: Initial Population

    Source: JIRA (CQM-1649)

  • Clarified Initial Population by adding Inpatient Encounters preceded by an emergency department visit (at the same physical facility) to meet measures intent.

    Section: Initial Population

    Source: JIRA (CQM-1605)

  • Moved Measure Population definition to the IP definition in order for the strata to work as intended and to align with the logic.

    Section: Initial Population

    Source: JIRA (CQM-1738)

  • 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.

    Section: Measure Observations

    Source: JIRA (CQM-1645)

  • Moved Measure Population definition to the IP definition in order for the strata to work as intended and to align with the logic.

    Section: Measure Population

    Source: JIRA (CQM-1738)

  • Added a definition for the exclusion Transfer from: Hospital Settings.

    Section: Measure Population Exclusions

    Source: JIRA (CQM-1475)

  • Added a definition for the exclusion Transfer from: Hospital Settings.

    Section: Measure Population Exclusions

    Source: JIRA (CQM-1757)

  • 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.

    Section: Rate Aggregation

    Source: JIRA (CQM-1645)

  • Updated language to clarify that the principal diagnosis consistent with psychiatric/mental health disorders is related to inpatient encounters.

    Section: Stratification

    Source: Measure Lead

Logic

  • Revised and moved Measure Population logic to the IP definition in order for the strata to work as intended.

    Section: Initial Population

    Source: JIRA (CQM-1738)

  • 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.

    Section: Measure Observations

    Source: JIRA (CQM-1645)

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

    Section: Measure Observations

    Source: QDM Standards

  • Revised and moved Measure Population logic to the IP definition in order for the strata to work as intended.

    Section: Measure Population

    Source: JIRA (CQM-1738)

  • Added an exclusion of Transfer from: Hospital Settings to meet the measure intent.

    Section: Measure Population Exclusions

    Source: JIRA (CQM-1475)

  • Added an exclusion of Transfer from: Hospital Settings to meet the measure intent.

    Section: Measure Population Exclusions

    Source: JIRA (CQM-1757)

  • Value set Hospital Settings (2.16.840.1.113762.1.4.1111.126): Added Hospital Settings.

    Section: Measure Population Exclusions

    Source: None

  • 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.

    Section: QDM Data Elements

    Source: QDM Standards

  • Value set Hospital Settings (2.16.840.1.113762.1.4.1111.126): Added Hospital Settings.

    Section: QDM Data Elements

    Source: None

  • Changed the logic of the strata to include principal diagnosis with Inpatient Encounter rather than the ED Visit to meet the measure intent.

    Section: Stratification

    Source: Measure Lead

  • Introduced the operator Intersection of to condense logic and reduce complexity.

    Section: Stratification

    Source: Measure Lead

  • 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.

    Section: Stratification

    Source: QDM Standards

  • Value set Principal (2.16.840.1.113883.3.117.1.7.1.14): Removed Principal.

    Section: Stratification

    Source: QDM Standards

Value Set

  • Value set Hospital Settings (2.16.840.1.113762.1.4.1111.126): Added Hospital Settings.

    Section: None

    Source: None

  • 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.

    Section: None

    Source: None

  • 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).

    Section: None

    Source: ICD-10 Addendum

External Resources