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 for emergency department patients admitted to inpatient status

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Measure specifications are in the Public Domain.

These performance measures are not clinical guidelines and do not establish a standard of medical care and have not been tested for all potential applications. The measures and specifications are provided without warranty.

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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 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 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 increase quality of care. Reducing this time potentially improves access to care specific to the patient condition and increases the capability to provide additional treatment. In recent times, EDs have experienced significant overcrowding. Although once only a problem in large, urban, teaching hospitals, the phenomenon has spread to other suburban and rural healthcare organizations. According to a 2002 national U.S. survey, more than 90 percent of large hospitals report EDs operating "at" or "over" capacity. Approximately one third of hospitals in the U.S. report increases in ambulance diversion in a given year, whereas up to half report crowded conditions in the ED. In a recent national survey, 40 percent of hospital leaders viewed ED crowding as a symptom of workforce shortages. ED crowding may result in delays in the administration of medication such as antibiotics for pneumonia and has been associated with perceptions of compromised emergency care. For patients with non-ST-segment-elevation myocardial infarction, long ED stays were associated with decreased use of guideline-recommended therapies and a higher risk of recurrent myocardial infarction. Overcrowding and heavy emergency resource demand have led to a number of problems, including ambulance refusals, prolonged patient waiting times, increased suffering for those who wait, rushed and unpleasant treatment environments, and potentially poor patient outcomes. When EDs are overwhelmed, their ability to respond to community emergencies and disasters may be compromised.

The most common cause of ED crowding is the boarding of admitted patients in the ED. Numerous studies have demonstrated the potential for errors, life threatening delays in treatment, and diminished overall quality is enormous.

Improvement noted as a decrease in the median value

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

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: Documentation of the decision to admit the patient from the ED that is closest to the inpatient admission. Specification: as admission processes vary at different hospitals, this can use 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.

TBD

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 unless the ED and admitting hospital share the same CCN

Initial Population

Emergency department encounters with an admission source in "Hospital Setting" (any different facility, even if part of the same hospital system) resulting in an inpatient stay

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

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

Emergency Department (ED) Measure Set