Median Admit Decision Time to ED Departure Time for Admitted Patients

Median time (in minutes) from admit decision time to time of departure from the emergency department (ED) for emergency department patients admitted to inpatient status

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Report total score and the following strata:
Stratification 1 - all patients seen in the ED and admitted as an inpatient who do not have an inpatient encounter principal diagnosis (rank = 1) consistent with psychiatric/mental health disorders
Stratification 2 - all patients seen in the ED and admitted as an inpatient who have an inpatient encounter principal diagnosis (rank = 1) consistent with psychiatric/mental health disorders

None

Calculate the duration in minutes between the Decision to Admit time and the departure time for each ED encounter 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 duration the patient was in the Emergency Department after the decision to admit, also stated as: the Datetime difference between the Emergency Department facility location departure date/time and the Decision to Admit date/time. The calculation requires the median across all ED encounter durations.

Reducing the time patients remain in the emergency department (ED) can improve access to treatment and quality of care (Morley et al., 2018). Morley's study indicates that ED overcrowding contributes to poor patient outcomes, increased mortality, delayed assessment and care, increased inpatient length of stay, risk of readmission, reduced satisfaction, and exposure to error. A review by Boudi et al. (2020) noted that ED boarding time (defined as the time between the decision to admit to inpatient and physical departure from the ED) is associated with adverse patient outcomes, such as delays in antibiotic administration, delays in pain medication administration, lower patient satisfaction, prolonged times to disposition among patients with acute asthma, and higher complication rates for cardiovascular events. Addressing critical gaps in patient throughput effectively and efficiently will shorten the length of stay and improve the delivery of safe, high-quality and patient-centered care.

Length of stay (LOS) in the emergency department is an important indicator and a tool to monitor emergency care. Increased LOS has been associated with delays in treatment, adverse outcomes, and decreased patient satisfaction (Mentzonie et al., 2019). Empirical evidence shows that shorter lengths of stay in the ED lead to improved clinical outcomes. Quality improvement efforts aimed at reducing length of ED stay and overcrowding have been associated with an increase in ED patient volume, decrease in number of patients who leave without being seen, reduction in costs, and increase in patient satisfaction (Bucci et al., 2016; Chang et al., 2017; Zocchi et al., 2015).

Improvement noted as a decrease in the median value

Reference Type: CITATION

Reference Text: 'American College of Emergency Physicians (ACEP). (2017). Clinical Policy: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department http://dx.doi.org/10.1016/j.annemergmed.2017.01.036'

Reference Type: CITATION

Reference Text: 'Boudi, Z., Lauque, D., Alsabri, M., Ostlundh, L., Oneyji, C., Khalemsky, A. et al. (2020) Association between boarding in the emergency department and in-hospital mortality: A systematic review. PLoS ONE 15(4): e0231253. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231253'

Reference Type: CITATION

Reference Text: 'Bucci, S., de Belvis, A. G., Marventano,S., De Leva, A. C., Tanzariello, M., Specchia, M. L., Ricciardi, W., and Franceschi, F., Emergency department crowding and hospital bed shortage: Is Lean a smart answer? A systematic review. Eur Rev Med Pharmacol Sci, 2016, 20(20), 4209-4219'

Reference Type: CITATION

Reference Text: 'Chang, A. M., Lin, A., Rongwei, F., McConnell, K. J., Sun, B. Associations of Emergency Department Length of Stay With Publicly Reported Quality-of-care Measures. Acad Emerg Med, 2017, 24(2), 246-250'

Reference Type: CITATION

Reference Text: 'Joint Commission (2012). APPROVED: Standards Revisions Addressing Patient Flow Through the Emergency Department. Joint Commission Perspectives (R). https://cdn2.hubspot.net/hubfs/3835765/BedWatch_August2017/Docs/Stds_Rev_Patient_Flow.pdf?t=1504703794448'

Reference Type: CITATION

Reference Text: 'Lester, N. A., Thompson, L. R., Herget, K., Stephens, J. A., Campo, J. V., Adkins, E. J., Terndrup, T. E., & Moffatt-Bruce, S. (2018). CALM Interventions: Behavioral Health Crisis Assessment, Linkage, and Management Improve Patient Care'

Reference Type: CITATION

Reference Text: 'Mentzoni et al. BMC Health Services Research (2019) 19:506 https://doi.org/10.1186/s12913-019-4342-4'

Reference Type: CITATION

Reference Text: 'Morley, C., Unwin, M., Peterson, G. M., Stankovich, J., Kinsman, L. (2018) Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS ONE 13(8): e0203316. https://doi.org/10.1371/journal.pone.0203316'

Reference Type: CITATION

Reference Text: 'Zocchi, M. S., M. S. McClelland, and J. M. Pines. Increasing Throughput: Results From A 42-Hospital Collaborative To Improve Emergency Department Flow. The Joint Commission Journal on Quality and Patient Safety, 2015, 41(12):532-542'

CMS Certification Number (CCN) is the hospitals identification number that is used for CMS certification

This measure specification delineates how to calculate the duration from the Decision to Admit to the departure from an Emergency Department (ED) visit.

Decision to Admit: Documentation of the decision to admit the patient from the ED that is closest to the inpatient admission and since admission processes vary at different hospitals this can use either of the following:
1. An Order- A) admission order (this may be an operational order rather than the hospital admission to inpatient status order), B) disposition order (must explicitly state to admit), C) documented bed request, or D) documented acceptance from admitting physician. This is not the "bed assignment time" or "report called time". Or
2. An Assessment- an ED evaluation that results in a decision to "Admit Inpatient"

The decision to admit inpatient must be performed during the ED visit that is within one hour of the inpatient admission and prior to the patient departing the ED.

The specification provides elements from the clinical electronic record required to calculate the median time, i.e., the duration from the decision to admit to the time the patient physically departed the ED.

Patients with behavioral health emergencies are stratified because often these situations are confounded by policies and practices in the community that are beyond the control of any individual hospital and present the hospital with quality and safety circumstances different from those of the acute medical patients (Joint Commission, 2012). Recent peer-reviewed studies also demonstrate the need for dedicated emergency mental health services, supplying evidence that the clinical needs for these patients substantively differ from the non-psychiatric population (American College of Emergency Physicians (ACEP), 2017; Lester, 2018).

The measure population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period. 

This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

Inpatient hospitalizations ending during the measurement period with length of stay less than or equal to 120 days, where the patient received services during the preceding emergency department (ED) visit at the facility when a decision to admit inpatient was made prior to departing the ED

Initial Population

Emergency department encounters with an admission source in "Hospital Setting" (any different facility- by location or CCN) resulting in an inpatient stay

Median time (in minutes) from the Decision to Admit to inpatient to the time the patient physically departs the ED to inpatient hospitalization

For every patient evaluated by this measure, also identify payer, race, ethnicity and sex

Emergency Department (ED) Measure Set