Urgent Matters E-Newsletter
Volume 6, Issue 1
September/October 2009
Special Focus Issue- Performance Measurement
Innovations
Developing Standards for ED Care, Urgent Matters Learning Network II
“The growing trend towards hospital performance measurement and public reporting may very well include the 5000+ hospital emergency departments in the next several years,” reports Mark McClelland, registered nurse and research scientist at the Center for Health Care Quality at The George Washington University Medical Center (GW). The six hospitals in the Urgent Matters Learning Network II (LNII), however, are not waiting for that time to come. Since January 2009, LNII hospitals have been working with seven ED related performance measures (see below) as part of their participation in Urgent Matters.
| Urgent Matters ED Performance Measures |
| *Time from ED Arrival to ED Departure - Admitted ED Patients |
| *Time from ED Arrival to ED Departure - Discharged ED Patients |
| *Admit Decision Time - Admitted ED Patients |
| Time to Pain Management - Admitted ED Patients |
| Time to Pain Management - Discharged ED Patients |
| Time to Chest X-Ray - Admitted ED Patients |
| Time to Chest X-Ray - Discharged ED Patients |
| *Identified by CMS for possible inclusion for public reporting |
The Center for Medicare and Medicaid Services (CMS) has already implemented multiple performance measures for public reporting. The cardiac and pneumonia core measures, the patient satisfaction measures, and the more recent hospital mortality and readmission rates are examples of what is now publicly reported on the Medicare’s Hospital Web site. “CMS is committed to increasing hospital quality, accountability and transparency by requiring hospitals to report these measures,” observes McClelland. “This is why the work being done in our Urgent Matters LNII hospitals is so important. We are field-testing the ED performance measures which CMS is considering for inclusion in the 2012 quality initiative updates.”
“Urgent Matters has been involved with ED performance measures going back to 2006” reports McClelland. That was when CMS, responding to concerns within the ED community about the lack of standardized performance measures, commissioned a Technical Expert Panel (TEP) to develop ED specific measures. “Standardized performance measures create common terminology and understanding that in turn provides opportunity for comparison and improvement”, explains McClelland. With advice from Urgent Matters and others in the ED community, the TEP developed a set of performance measures which were then submitted to the National Quality Forum (NQF) for endorsement. In October, 2008 the NQF endorsed ten ED performance measures. CMS is considering including three of these measures in its inpatient and outpatient payment updates for 2012. LNII hospitals are pioneers in the field of ED quality improvement by becoming the first hospitals in the United States to field-test the ED standard performance measures. “This is an opportunity for providers in the field of emergency care to share their real world experience and expertise and take a central role in the development and testing of standard performance measures,” adds McClelland.
The LNII hospitals collect and report data monthly to the Urgent Matters staff on the seven measures listed above. In conjunction with reporting the required data the hospitals are also submitting descriptions of the resources used and challenges associated with data collection. The LNII hospitals are truly field-testing these measures; they have identified circumstances where the performance measures are ambiguous or do not reflect relevant processes. The Urgent Matters team will summarize the data and lessons learned, and then forward the information to CMS for review and consideration as it moves forward with its plan to push these measures out into the public domain.
“There is a long way to go before the ED performance measures can be used for hospital comparison on a national basis. Issues including hospital size, patient mix and teaching status all need to be considered before national benchmarks can be developed.” Nevertheless, McClelland is optimistic, “The Urgent Matters LNII hospitals are making an exciting contribution and building a solid foundation for standardized ED performance measurement.”
Mark McClelland MN, RN, Research Scientist, The George Washington University Medical Center, Center for Health Care Quality
