This is a relatively intriguing public policy article in JAMA following up in a timely fashion regarding the new CMS Emergency Department quality measures. These new measures include various time-to-X measures, including length of stay, length of time to admission from bed request, etc. There is some concern that these quality measures may be tied to federal funding, unfairly targeting “safety-net” hospitals that are not at baseline provided with the resources to address patient flow issues.
This article is a review of the NHAMCS database, a national probability sample survey of patient visits, looking at independent predictors of increased length of stay in patients admitted and discharged from the Emergency Department. Based on the review of this sample, they do not see a significant difference in ED length of stay – and conclude that these quality measures should not be of concern to “safety net” EDs. However, these general time-based measures mask most of the problems encountered in “safety net” institutions.
There are some baseline differences in patient characteristics between the safety-net and non-safety-net hospitals in their sample, and they tend to work in favor of safety-net hospitals. The safety net hospitals in this sample tended to have younger patients with lower triage acuities, which should work in favor of reduced ED overall average length of stay. My anecdotal experience suggests that, once the quality measures track more detailed ED transit times, I believe we will see more significant deficiencies drop out in the safety-net group.
“Association of Emergency Department Length of Stay With Safety-Net Status”