Speed of ED Care Goes Under Quality Microscope

Cheryl Clark, July 28, 2011

Recently, I asked an emergency room physician a question that got a chuckle.

What, exactly, is "the door" -- as in "door-to-decision," "door-to-bed," "door-to-balloon," "door-to-scan" or "door-to-departure"?  

How do you know when the patient actually came in "the door," to measure the speed of care, which of course closely relates to quality of care?

And while we're at it, what is really meant by "departure" from the ED, given the vagaries of the time so many patients spend on gurneys parked along hospital hallways?

The physician laughed, but in a good way, as if I had posed a question many other providers have also been asking. "Good question" was the response.

Now coalitions of emergency physicians and emergency nurses have taken the first steps to find some answers and define words or phrases commonly used in ED care, but which have meant different things in different settings – and resolve what has been a long-standing battleground over terminology.

"There's been a problem with people in EDs measuring different metrics, and there's been a problem with different definitions of metrics," says Sandra Schneider, president of the American College of Emergency Physicians, which participated in both coalitions.


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