Emergency Department Performance Measures Updates: Proceedings of the 2014 Emergency Department Benchmarking Alliance Consensus Summit

Abstract

Objectives: The objective was to review and update key definitions and metrics for emergency department (ED) performance and operations.Methods: Forty-five emergency medicine leaders convened for the Third Performance Measures and Benchmarking Summit held in Las Vegas, February 21-22, 2014. Prior to arrival, attendees were assigned to workgroups to review, revise, and update the definitions and vocabulary being used to communicate about ED performance and operations. They were provided with the prior definitions of those consensus summits that were published in 2006 and 2010. Other published definitions from key stakeholders in emergency medicine and health care were also reviewed and circulated. At the summit, key terminology and metrics were discussed and debated. Workgroups communicated online, via teleconference, and finally in a face-to-face meeting to reach consensus regarding their recommendations. Recommendations were then posted and open to a 30-day comment period. Participants then reanalyzed the recommendations, and modifications were made based on consensus.Results: A comprehensive dictionary of ED terminology related to ED performance and operation was developed. This article includes definitions of operating characteristics and internal and external factors relevant to the stratification and categorization of EDs. Time stamps, time intervals, and measures of utilization were defined. Definitions of processes and staffing measures are also presented. Definitions were harmonized with performance measures put forth by the Centers for Medicare and Medicaid Services (CMS) for consistency.Conclusions: Standardized definitions are necessary to improve the comparability of EDs nationally for operations research and practice. More importantly, clear precise definitions describing ED operations are needed for incentive-based pay-for-performance models like those developed by CMS. This document provides a common language for front-line practitioners, managers, health policymakers, and researchers.ACADEMIC EMERGENCY MEDICINE 2015;22:542-553

Successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients

“…All sites excluded children who received any antibiotics prior to arrival at the respective institution. Time to antibiotic (TTA) delivery was defined as the difference in time from ED nurse documentation of first antibiotic administration time and ED arrival time (in minutes), a standard US ED metric 16. The baseline mean TTA were 118.5 minutes, 163.0 minutes, and 188.0 for Centers 1, 2, and 3 respectively (Figs.…”

Should Emergency Department Attendances be Used With or Instead of Readmission Rates as a Performance Metric?

“…In addition to considering the precise nature of the return-to-acute-care, the most appropriate time window also needs to be considered. 72 hours to seven days has been used as the ED reattendance time window, 14 whereas the 30-day window is most commonly used for readmissions but is arbitrary: the 7-day window is more specific to the index hospitalisation, whereas a longer follow-up period will lead to more numerically robust rates.…”

Associations of Emergency Department Length of Stay With Publicly Reported Quality‐of‐care Measures

“…We included hospitals reporting Hospital Compare timeliness measures of ED LOS for admitted patients. This is defined as the median time from ED arrival to ED departure for admitted ED patients . We excluded facilities that were primarily pediatric, specialty, critical access, or Veterans Affairs hospitals; facilities with less than 10,000 ED admissions in either 2012 or 2013 per AHA data; and facilities that reported LOS times of 0.…”