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Quality Measurement In The Emergency Department: Past And Future

ABSTRACT: As the United States seeks to improve the value of health care, there is an urgent need to develop quality measurement for emergency departments (EDs). EDs provide 130 million patient visits per year and are involved in half of all hospital admissions. Efforts to measure ED quality are in their infancy, focusing on a small set of conditions and timeliness measures, such as waiting times and length-of-stay. We review the history of ED quality measurement, identify policy levers for implementing performance measures, and propose a measurement agenda. Initial priorities include measures of effective care for serious conditions that are commonly seen in EDs, such as trauma; measures of efficient use of resources, such as high-cost imaging and hospital admission; and measures of diagnostic accuracy. More research is needed to support the development of measures of care coordination and regionalization and the episode cost of ED care. Policy makers can advance quality improvement in ED care by asking ED researchers and organizations to accelerate the development of quality measures of ED care and incorporating the measures into programs that publicly report on quality of care and incentive-based payment systems.

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The Past, Present, and Future of Urgent Matters: Lessons Learned from a Decade of Emergency Department Flow Improvement

ABSTRACT: Over the past decade, emergency departments (ED) have encountered major challenges due to increased crowding and a greater public focus on quality measurement and quality improvement. Responding to these challenges, many EDs have worked to improve their processes and develop new and innovative models of care delivery. Urgent Matters has contributed to ED quality and patient flow improvement by working with hospitals throughout the United States. Recognizing that EDs across the country are struggling with many of the same issues, Urgent Matters—a program funded by the Robert Wood Johnson Foundation (RWJF)—has sought to identify, develop, and disseminate innovative approaches, interventions, and models to improve ED flow and quality. Using a variety of techniques, such as learning networks (collaboratives), national conferences, e-newsletters, webinars, best practices toolkits, and social media, Urgent Matters has served as a thought leader and innovator in ED quality improvement initiatives. The Urgent Matters Seven Success Factors were drawn from the early work done by program participants and propose practical guidelines for implementing and sustaining ED improvement activities.This article chronicles the history, activities, lessons learned, and future of the Urgent Matters program.

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Robert Wood Johnson Foundation: The Synthesis Project, Emergency Department Utilization and Capacity, July 2009

The hospital emergency department (ED) plays a unique and important role in the American health sector and broader society. EDs are designed to treat the most critically ill and injured patients and they are part of the first response to public health emergencies such as natural disasters and terrorist attacks. In addition, EDs also serve as a bellwether of performance in other parts of the health care system. For example, limited access to primary care often reveals itself in non-urgent or preventable care provided in the ED (125, 14, 135).1 The availability and utilization of ED care can reveal limitations in other areas such as inpatient and psychiatric capacity. The ED has also been described as the "safety net for the safety net" as it is the one place where patients know they can be seen regardless of financial resources or time of day (146).

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GAO-09-374: Hospital Emergency Departments, Crowding Continues to Occur, and Some Patients Wait Longer than Recommended Time Frames, April 30, 2009

Open 24 hours a day, 7 days a week, hospital emergency departments are a major part of the nation’s health care safety net. Of the estimated 119 million visits to U.S. emergency departments in 2006, over 40 percent were paid for by federally-supported programs.1 These programs— Medicare, Medicaid, and the State Children’s Health Insurance Program2— are administered by the Department of Health and Human Services (HHS). Emergency department staff report being under increasing pressure, and concerns have been raised that they face challenges in providing timely and effective emergency medical care.

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Measures can help decrease wait time, increase physician productivity, and safetyWashington, DC - To reduce overcrowding, decrease patient wait time, and improve quality of care, the National Quality Forum (NQF) endorsed 10 national voluntary consensus standards for hospital-based emergency department care. The measures aim to improve efficiency and care coordination in emergency departments where high demand and capacity issues have increased patient wait time and decreased physician productivity.

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CDC Releases New Emergency Department Data, August 6, 2008

The National Center for Health Statistics (NCHS), part of the Centers for Disease Control and Prevention (CDC), has released a new report on emergency department (ED) utilization in the United States. The report contains data from the 2006 National Hospital Ambulatory Medical Care Survey (NHAMCS). According to the report, between 1996 and 2006, the annual number of ED visits in the United States increased by 32 percent. However, the number of hospital EDs has decreased from 4,019 to 3,833 (5 percent), resulting in more visits per ED and increased wait times. 

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Assessing Health and Health Care in the District of Columbia, February 7, 2008 

RAND, in partnership with the George Washington University Department of Health Policy, recently released a working paper describing interim findings from a study of health and the health care service delivery system in the District of Columbia. The goals of the study are to: (1) conduct a comprehensive health needs assessment for Washington DC; (2) assess the quality and accessibility of the District’s health care delivery system for individuals with urgent or emergent medical needs; and (3) use information from those assessments to identify and assess various policy options for improving the health care delivery system. This document summarizes findings related to the first two goals. A final report will include findings relevant to goal three. 

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Emergency Department Performance Measures: Creating Consistency in a Chaotic Environment, November 15, 2006 

In February 2006, nineteen influential members of the emergency medicine community met in Atlanta to discuss and develop performance measures for the emergency department (ED). The purpose of the meeting was to begin the process of standardizing the terminology and implementation of ED performance measures that will serve as markers of operational quality. The resulting Consensus Statement produced by the Atlanta summit is being circulated among the emergency medicine community for comment and discussion. Additionally, this report was recently published in Academic Emergency Medicine: Acad Emerg Med. 2006 Oct; 13(10):1074-80. 

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