Median time from admit decision time to time of departure from the emergency department for emergency department patients admitted to inpatient status. Centers for Medicare & Medicaid Services Centers for Medicare & Medicaid Services Centers for Medicare & Medicaid Services A decrease in the median value 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 U.S. survey, more than 90 percent of large hospitals report EDs operating "at" or "over" capacity. Approximately one third of hospitals in the US 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. 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. Sacco RL, et al. Stroke Vol 37, 2006:577 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. None

Length of stay <= 120 days: Duration of encounter (encounter end time - encounter start time) is lesss than or equal to 120 days. Inpatient encounter: An encounter, where encounter type <= value set InpatientEncounter. ED encounter: An encounter, where encounter type <= HL7 ActCode EMER "Emergency encounter". Observation status: A status where patient requires prolonged monitoring, without necessarily requiring an inpatient admission. Listed for admission: A status where a patient is to be admitted to the hospital. Physically departed from ED: Patient has physically left the emergency department. Patient is observation status Physically departed from ED

Initial Patient Population =
AND: Inpatient encounter where AND: Length of Stay <= 120 days. Measure Population =
AND: Inpatient encounter where AND: Length of Stay <= 120 days; AND: Preceded by ED encounter in facility's ED, where patient NOT Observation status.

Time from admit decision to physical departure from the emergency department = ListedForAdmission.effectiveTime - PhysicallyDepartedFromED.effectiveTime. Time from admit decision to physical departure from the emergency department. ListedForAdmission.effectiveTime - PhysicalDepartureFromED.effectiveTime PhysicallyDepartedFromED ListedForAdmission