When the government is the largest healthcare payor, you pay attention when they start measuring “quality” – because it’s usually not long after that payments are tied to “quality”.
This is an Annals study looking at the pilot reporting program from CMS, which includes seven metrics that hospitals are going to have report in the next two years. These metrics are:
– Throughput time for admitted patients.
– Throughput time for discharged patients.
– Admit order to bed placement for admitted patients.
– Time to pain management for long bone fractures (discharged and admitted)
– Time to chest x-ray after order placed (discharged and admitted)
I love the pain management metric. The literature that supports how poorly ED physicians manage pain is extensive. Not a day goes by where have a resident trying to give a 2 milligram dose of morphine to treat acute pain. The other metrics – well, so, faster is more and more is better, so therefore more, faster is “quality”, right? Well, there are some studies that show improved outcomes when patients reach the floor more rapidly, so, perhaps that’s what they’re getting at. I don’t know if we’ll ever really know how improving these measures affects quality, because there are so many other confounding variables affecting these issues.
What is good about these metrics is that it should make a lot of EDs re-examine their processes and see how they can maximize the resources they have. But, after the low-hanging fruit, you run up against issues of physical and financial resources – many of which are hospital-wide issues. It will be interesting to see how our workplace changes in response to this. Unsurprisingly, academic centers and busy EDs had the worst throughput statistics; not sure about magical solutions there.
“A Field-Test of Time-Based Emergency Department Quality Measures.”
www.ncbi.nlm.nih.gov/pubmed/21868129