eCQM Title | Median Admit Decision Time to ED Departure Time for Admitted Patients |
||
---|---|---|---|
eCQM Identifier (Measure Authoring Tool) | 111 | eCQM Version Number | 9.1.000 |
NQF Number | Not Applicable | GUID | 979f21bd-3f93-4cdd-8273-b23dfe9c0513 |
Measurement Period | January 1, 20XX through December 31, 20XX | ||
Measure Steward | Centers for Medicare & Medicaid Services (CMS) | ||
Measure Developer | Oklahoma Foundation for Medical Quality | ||
Endorsed By | None | ||
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 |
||
Copyright |
Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. Mathematica disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the measure specifications is copyright 2004-2019 American Medical Association. LOINC(R) copyright 2004-2019 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2019 International Health Terminology Standards Development Organisation. ICD-10 copyright 2019 World Health Organization. All Rights Reserved. |
||
Disclaimer |
These performance measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATION ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]. |
||
Measure Scoring | Continuous Variable | ||
Measure Type | Process | ||
Stratification |
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 |
||
Risk Adjustment |
None |
||
Rate Aggregation |
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. |
||
Rationale |
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. |
||
Clinical Recommendation Statement |
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 Notation |
Improvement noted as a decrease in the median value |
||
Reference |
Derlet, R. W., & Richards J. R. (2002). Emergency department overcrowding in Florida, New York, and Texas. Southern Medical Journal, 95, 846-849. |
||
Reference |
Derlet, R. W., & Richards J. R. (2000). Overcrowding in the nation’s emergency departments: Complex causes and disturbing effects. Annals of Emergency Medicine, 35, 63-68. |
||
Reference |
Diercks, D. B., Roe, M. T., Chen, A. Y., et al. (2007). Prolonged emergency department stays of non-ST-segment-elevation myocardial infarction patients are associated with worse adherence to the American College of Cardiology/American Heart Association guidelines for management and increased adverse events. Annals of Emergency Medicine, 50, 489-496. |
||
Reference |
Fatovich, D. M., & Hirsch, R. L. (2003). Entry overload, emergency department overcrowding, and ambulance bypass. Emergency Medicine Journal, 20, 406-409. |
||
Reference |
Hwang, U., Richardson, L. D., Sonuyi, T. O., et al. (2006). The effect of emergency department crowding on the management of pain in older adults with hip fracture. Journal of the American Geriatrics Society, 54, 270-275. |
||
Reference |
Institute of Medicine. (2006). IOM report: The future of emergency care in the United States health system. Academic Emergency Medicine, 13(10), 1081-1085. |
||
Reference |
Institute of Medicine of the National Academies. (2006). Future of emergency care: Hospital-based emergency care at the breaking point. Washington, DC: National Academies Press. |
||
Reference |
Krochmal, P., & Riley, T. A. (1994). Increased health care costs associated with ED overcrowding. American Journal of Emergency Medicine, 12, 265-266. |
||
Reference |
Kyriacou, D. N., Ricketts, V., Dyne, P. L., et al. (1999). A 5-year time study analysis of emergency department patient care efficiency. Annals of Emergency Medicine, 34, 326-335. |
||
Reference |
Nawar, E. D., Niska, R. W., & Xu, J. (2007). National Hospital Ambulatory Medical Care Survey: 2005 emergency department summary. Advance Data, 386, 1-32. |
||
Reference |
Richardson, D. B. Increase in patient mortality at 10 days associated with emergency department overcrowding. (2006). Medical Journal of Australia, 184, 213-216. |
||
Reference |
Sprivulis, P. C., Da Silva, J. A., Jacobs, I. G., et al. (2006). The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Medical Journal of Australia, 184, 208-212. |
||
Reference |
Trzeciak, S., & Rivers, E. P. (2003). Emergency department overcrowding in the United States: An emerging threat to patient safety and public health. Emergency Medicine Journal, 20, 402-405. |
||
Reference |
U.S. General Accounting Office. (2003). Hospital emergency departments: Crowded conditions vary among hospitals and communities. GAO-03-460. Washington, DC: Author. |
||
Reference |
Wilper, A. P., Woolhandler, S., Lasser, K. E., et al. (2008). Waits to see an emergency department physician: U.S. trends and predictors, 1997–2004. Health Affairs (Millwood), 27, w84-w95. |
||
Definition |
CMS Certification Number (CCN) is the hospitals identification number that is used for CMS certification |
||
Guidance |
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 1 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. This eCQM is an episode-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM. |
||
Transmission Format |
TBD |
||
Initial Population |
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 |
||
Measure Population |
Initial Population |
||
Measure Population Exclusions |
Emergency department encounters with an admission source in "Hospital Setting" (any different facility- by location or CCN) resulting in an inpatient stay |
||
Measure Observations |
Median time (in minutes) from the Decision to Admit to inpatient to the time the patient physically departs the ED to inpatient hospitalization |
||
Supplemental Data Elements |
For every patient evaluated by this measure, also identify payer, race, ethnicity and sex |
"ED Encounter with Decision to Admit"
"Initial Population"
/*Exclude the most recent ED encounter (LastEDVisit) that occurred within an hour of the inpatient admission with ED admission source in "Hospital Setting" (any different facility- by location or CCN )*/ Global."Inpatient Encounter" EncounterInpatient where "LastEDEncounter"(EncounterInpatient).admissionSource in "Hospital Settings"
/*Patient encounters without a principal diagnosis (rank=1) of "Psychiatric/Mental Health Diagnosis*/ Global."Inpatient Encounter" EncounterInpatient where not exists ( EncounterInpatient.diagnoses Diagnosis where Diagnosis.code in "Psychiatric/Mental Health Diagnosis" and Diagnosis.rank = 1 )
/*Patient encounters with a principal diagnosis (rank=1) of "Psychiatric/Mental Health Diagnosis*/ Global."Inpatient Encounter" EncounterInpatient where exists ( EncounterInpatient.diagnoses Diagnosis where Diagnosis.code in "Psychiatric/Mental Health Diagnosis" and Diagnosis.rank = 1 )
Median ( /*The duration from the Decision to Admit (order or assessment) to the departure from the Emergency Department*/ duration in minutes of Interval[Coalesce("AdmitDecisionUsingAssessmentDuringLastEDBeforeDeparture"(EncounterInpatient).relevantDatetime, "AdmitDecisionUsingEncounterOrderDuringLastEDandBeforeDeparture"(EncounterInpatient).authorDatetime), "EDDepartureTime"("LastEDEncounter"(EncounterInpatient))] )
/*Constrains the inpatient encounter to having an ED visit with a decision to admit (assessment or order) to inpatient and ED facility location period is not null*/ from Global."Inpatient Encounter" EncounterInpatient let LastEDVisit: LastEDEncounter(EncounterInpatient) where ( "AdmitDecisionUsingAssessmentDuringLastEDBeforeDeparture"(EncounterInpatient).relevantDatetime during LastEDVisit.relevantPeriod or "AdmitDecisionUsingEncounterOrderDuringLastEDandBeforeDeparture"(EncounterInpatient).authorDatetime during LastEDVisit.relevantPeriod ) and exists ( LastEDVisit.facilityLocations Location where Location.code in "Emergency Department Visit" and end of Location.locationPeriod != maximum DateTime )
"ED Encounter with Decision to Admit"
["Encounter, Performed": "Emergency Department Visit"]
["Encounter, Performed": "Encounter Inpatient"] EncounterInpatient where "LengthInDays"(EncounterInpatient.relevantPeriod)<= 120 and EncounterInpatient.relevantPeriod ends during "Measurement Period"
"Initial Population"
/*Exclude the most recent ED encounter (LastEDVisit) that occurred within an hour of the inpatient admission with ED admission source in "Hospital Setting" (any different facility- by location or CCN )*/ Global."Inpatient Encounter" EncounterInpatient where "LastEDEncounter"(EncounterInpatient).admissionSource in "Hospital Settings"
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
/*Patient encounters without a principal diagnosis (rank=1) of "Psychiatric/Mental Health Diagnosis*/ Global."Inpatient Encounter" EncounterInpatient where not exists ( EncounterInpatient.diagnoses Diagnosis where Diagnosis.code in "Psychiatric/Mental Health Diagnosis" and Diagnosis.rank = 1 )
/*Patient encounters with a principal diagnosis (rank=1) of "Psychiatric/Mental Health Diagnosis*/ Global."Inpatient Encounter" EncounterInpatient where exists ( EncounterInpatient.diagnoses Diagnosis where Diagnosis.code in "Psychiatric/Mental Health Diagnosis" and Diagnosis.rank = 1 )
/*Captures the decision to admit assessment, time, and result that was performed during the last ED visit*/ Last(["Assessment, Performed": "Emergency Department Evaluation"] EDEvaluation let LastEDVisit: "LastEDEncounter"(EncounterInpatient) where EDEvaluation.relevantDatetime during LastEDVisit.relevantPeriod and EDEvaluation.result in "Admit Inpatient" and EDEvaluation.relevantDatetime before or on "EDDepartureTime"(LastEDVisit) sort by relevantDatetime )
/*Captures the decision to admit order and time that occured during the last ED visit*/ Last(["Encounter, Order": "Decision to Admit to Hospital Inpatient"] AdmitOrder let LastEDVisit: "LastEDEncounter"(EncounterInpatient) where AdmitOrder.authorDatetime during LastEDVisit.relevantPeriod and AdmitOrder.authorDatetime before or on "EDDepartureTime"(LastEDVisit) sort by authorDatetime )
/*The time the patient physically departed the Emergency Department*/ Last(Encounter.facilityLocations Location where Location.code in "Emergency Department Visit" and end of Location.locationPeriod != maximum DateTime return end of Location.locationPeriod sort ascending )
/*The most recent (last) ED encounter that is within an hour of an inpatient encounter*/ Last(Global."ED Encounter" EDVisit where EDVisit.relevantPeriod ends 1 hour or less before or on start of EncounterInpatient.relevantPeriod sort by end of relevantPeriod ascending )
difference in days between start of Value and end of Value
/*The duration from the Decision to Admit (order or assessment) to the departure from the Emergency Department*/ duration in minutes of Interval[Coalesce("AdmitDecisionUsingAssessmentDuringLastEDBeforeDeparture"(EncounterInpatient).relevantDatetime, "AdmitDecisionUsingEncounterOrderDuringLastEDandBeforeDeparture"(EncounterInpatient).authorDatetime), "EDDepartureTime"("LastEDEncounter"(EncounterInpatient))]
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
Measure Set |
Emergency Department (ED) Measure Set |
---|