Median time from emergency department arrival to time of departure from the emergency room for patients discharged from the emergency department.

None

None

The measure is stratified. Stratum 1 - all discharged ED patients; Stratum 2 – all patients with diagnosis consistent with mental disorders; Stratum 3 – all patients transferred to another acute care hospital; and Stratum 4 – all patients other than those included in populations 2 and 3.
Do Not Include in any of the Strata: Patients who are not an ED Patient; Patients who expire in the ED; Patients admitted to the hospital from the ED.

None

None

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. 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. 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. When EDs are overwhelmed, their ability to respond to community emergencies and disasters may be compromised.

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.

A decrease in the median value indicates less time in the emergency department and enhances throughput.

Diercks DB, et al. 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. Ann Emerg Med.2007;50:489-96.

Derlet RW, Richards JR. Emergency department overcrowding in Florida, New York, and Texas. South Med J. 2002;95:846-9

Derlet RW, Richards JR. Overcrowding in the nation's emergency departments: complex causes and disturbing effects.

Fatovich DM, Hirsch RL. Entry overload, emergency department overcrowding, and ambulance bypass. Emerg Med J. 2003;
Ann Emerg Med. 2000;35:63-8.
20:406-9

Hwang U, Richardson LD, Sonuyi TO, Morrison RS. The effect of emergency department crowding on the management of pain in older adults with hip fracture. J Am Geriatr Soc. 2006;.
54:270-5

Institute of Medicine of the National Academies. Future of emergency care: Hospital-based emergency care at the breaking point. The National Academies Press 2006.

Kyriacou DN, Ricketts V, Dyne PL, McCollough MD, Talan DA. A 5-year time study analysis of emergency department patient care efficiency. Ann Emerg Med. 1999;34:326-35

Pines JM, et al. ED crowding is associated with variable perceptions of care compromise. Acad Emerg Med. 2007;14:1176-81.

Pines JM, et al. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008;51:6-7.

Schull MJ, et al. Emergency department crowding and thrombolysis delays in acute myocardial infarction. Ann Emerg Med. 2004;44:577-85.

Siegel B, et al. Enhancing work flow to reduce crowding. Jt Comm J Qual Patient Saf. 2007;33(11 Suppl):57-67.

Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003;20:402-5

Wilper AP, Woolhandler S, Lasser KE, McCormick D, Cutrona SL, Bor DH, Himmelstein DU. Waits to see an emergency department physician: U.S. trends and predictors, 1997-2004. Health Aff (Millwood). 2008;.
27:w84-95.

None

This measure uses a continuous variable.  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, 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].departuredatetime - [Encounter: encounter ED].arrivaldatetime).

The measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan – Mar, Q2 = Apr – Jun, Q3 = Jul – Sep, Q4 is Oct – Dec.

None

Patients seen in an emergency department and discharged.

Not applicable

Not applicable

Not applicable

Not applicable

Not applicable

Any emergency department (ED) visit during the measurement period.

Median Time (in minutes) from ED arrival to ED departure for patients discharged from the emergency department.

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