Skip to main content

The AHRQ National Quality Measures Clearinghouse (NQMC, qualitymeasures.ahrq.gov) Web site will not be available after July 16, 2018 because federal funding
through AHRQ will no longer be available to support the NQMC as of that date. For additional information, read our full announcement.
  • Measure Summary
  • NQMC:011292
  • Jan 2018
  • NQF-Endorsed Measure

Emergency department (ED): admit decision time to ED departure time for admitted patients.

Specifications manual for national hospital inpatient quality measures, version 5.3. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2018 Jan 1. various p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

This measure updates a previous version: Specifications manual for national hospital inpatient quality measures, version 5.0b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2015 Oct 1. various p.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Clinical Quality Measure: Access

Description

This measure is used to assess the median time from admit decision time to time of departure from the emergency department (ED) for admitted patients.

This measure represents the overall rate. The following rates are also reported:

  • Reporting measure
  • Psychiatric/mental health patients

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 United States (U.S.) survey, more than 90% 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% 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.

Evidence for Rationale

Specifications manual for national hospital inpatient quality measures, version 5.3. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2018 Jan 1. various p.

Primary Health Components

Emergency department (ED); admit decision time; departure time

Denominator Description

Any emergency department (ED) patient (as defined in the Data Dictionary), regardless of age, from the facility's ED (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Continuous variable statement: Time (in minutes) from admit decision time to time of departure from the emergency department (ED) for admitted patients

Type of Evidence Supporting the Criterion of Quality for the Measure

  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Accreditation

Collaborative inter-organizational quality improvement

External oversight/Medicaid

External oversight/Medicare

Internal quality improvement

Pay-for-reporting

Public reporting

Measurement Setting

Emergency Department

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Does not apply to this measure (e.g., measure is not provider specific)

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

All ages

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

IOM Domain

Effectiveness

Timeliness

Case Finding Period

Discharges January 1 through June 30

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Encounter

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Any emergency department (ED) patient (as defined in the Data Dictionary), regardless of age, from the facility's ED

Exclusions
Patients who are not an ED patient (as defined in the Data Dictionary)

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Continuous variable statement: Time (in minutes) from admit decision time to time of departure from the emergency department (ED) for admitted patients

Exclusions
Unspecified

Numerator Search Strategy

Institutionalization

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

  • Global Initial Patient Population Algorithm Flowchart
  • ED-2: Admit Decision Time to ED Departure Time for Admitted Patients Flowchart

Measure Specifies Disaggregation

Measure is disaggregated into categories based on different definitions of the denominator and/or numerator

Basis for Disaggregation

This measure is disaggregated according to the following categories:

  • Reporting measure
  • Psychiatric/mental health patients

Data Reported As: Aggregate measure of central tendency.

Scoring

Mean/Median

Interpretation of Score

Desired value is a lower score

Allowance for Patient or Population Factors

Does not apply to this measure

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Original Title

ED-2: admit decision time to ED departure time for admitted patients.

Measure Collection Name

National Hospital Inpatient Quality Measures

Measure Set Name

Emergency Department (ED) Measures

Submitter

Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]

Developer

Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]

Funding Source(s)

Centers for Medicare & Medicaid Services (CMS) funding is from the United States Government.

Composition of the Group that Developed the Measure

Centers for Medicare & Medicaid Services (CMS) Oklahoma Foundation for Medical Quality (contractor for CMS)

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Endorser

National Quality Forum

NQF Number

0497

Date of Endorsement

2017 Aug 1

Measure Initiative(s)

Hospital Compare

Hospital Inpatient Quality Reporting Program

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2018 Jan

Measure Maintenance

This measure is reviewed and updated every 6 months.

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: Specifications manual for national hospital inpatient quality measures, version 5.0b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2015 Oct 1. various p.

Source(s)

Specifications manual for national hospital inpatient quality measures, version 5.3. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; Effective 2018 Jan 1. various p.

Measure Availability

Source available from the QualityNet Web site External Web Site Policy.

Check the QualityNet Web site regularly for the most recent version of the specifications manual and for the applicable dates of discharge.

Companion Documents

The following are available:

  • A software application designed for the collection and analysis of quality improvement data, the CMS Abstraction and Reporting Tool (CART), is available from the QualityNet Web site External Web Site Policy.
  • Hospital compare: a quality tool provided by Medicare. [internet]. Washington (DC): U.S. Department of Health and Human Services; [accessed 2017 Oct 10]. Available from the Medicare Web site External Web Site Policy.

NQMC Status

This NQMC summary was originally completed by ECRI Institute on October 25, 2010. The information was not verified by the Centers for Medicare & Medicaid Services (CMS).

This NQMC summary was retrofitted into the new template on May 18, 2011.

The Joint Commission informed NQMC that this measure was updated on February 16, 2012 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on July 31, 2012. The information was verified by CMS on August 1, 2012.

The Joint Commission and CMS informed NQMC that this measure was updated on June 10, 2013 and provided an updated version of the NQMC summary. This NQMC summary was updated accordingly by ECRI Institute on October 11, 2013.

This NQMC summary was updated by ECRI Institute on July 7, 2015. The information was verified by the measure developer on August 3, 2015.

This NQMC summary was edited by ECRI Institute on November 16, 2015.

This NQMC summary was updated again by ECRI Institute on October 16, 2017. The information was verified by the measure developer on November 8, 2017.

Copyright Statement

No copyright restrictions apply.

NQMC Disclaimer

The National Quality Measures Clearinghouse™ (NQMC) does not develop, produce, approve, or endorse the measures represented on this site.

All measures summarized by NQMC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public and private organizations, other government agencies, health care organizations or plans, individuals, and similar entities.

Measures represented on the NQMC Web site are submitted by measure developers, and are screened solely to determine that they meet the NQMC Inclusion Criteria.

NQMC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or its reliability and/or validity of the quality measures and related materials represented on this site. Moreover, the views and opinions of developers or authors of measures represented on this site do not necessarily state or reflect those of NQMC, AHRQ, or its contractor, ECRI Institute, and inclusion or hosting of measures in NQMC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding measure content are directed to contact the measure developer.