Hospital leaders who believe their emergency room patients' wait times compare well with competitors may have to rethink those assumptions now that two ED wait time quality metrics are posted on the Hospital Compare website.
The times for the 74 hospitals—the first to volunteer their data—show wide variation across the country.
For example, for the first measure (ED-1)—the median time between when patients enter the ED door until they leave the ED for an inpatient bed—times range from 387 minutes at Niagara Falls Memorial Hospital in Niagara Falls, NY, and 358 minutes for Memorial Hermann Baptist Orange Hospital in Orange, TX, to 52 minutes at Perry Memorial Hospital in Perry, OK, and 90 minutes at Paynesville Area Hospital in Paynesville, MN.
Best-practice hospitals keep this time under four hours for all patients, not just as the median, says Sandra Schneider, MD, past president of the American College of Emergency Physicians who has studied the issue and visited EDs around the country. However, 18 of the 74 hospitals posted median times of four hours or longer.
Times for the second metric in the database (ED-2)—the median time between the moment an ED doctor decides to admit patients to an inpatient bed and the time the patients actually left the ED for that bed—range from 170 minutes, both at Memorial Hermann Baptist Hospital in Beaumont, TX, and Niagara Falls Memorial, to no minutes at both Frio Regional Hospital in Pearsall, TX, and Pocahontas Memorial Hospital in Buckeye, WV.
Best practice for this measure, Schneider says, is less than one hour. Thirty hospitals exceeded this time.
These time points were reported as part of a Centers for Medicare & Medicaid Services pilot program, announced Aug. 16, 2010, for patients who were sick enough to be admitted, and who were discharged during the first quarter of 2011. The data were posted in mid-April.
Reporting for all hospitals, based on a 2% pay-for-performance incentive, began Jan. 1, 2012, along with a third wait time measure (ED-3) for patients treated and released, and eventually, for determination of payment.
Schneider, an emergency room physician in Rochester, NY, says that while she's disappointed only 74 hospitals volunteered for this first round of reporting, emergency room physicians around the country are delighted that these wait times are now publicly reported.
"This is the first public look, and we're thrilled," Schneider says. "It says that CMS is finally paying attention to what we believe is the most important patient safety issue in all of emergency care: the issue of patients being boarded in the ED and staying for extensive periods of time." This issue was not only hidden from the public, she adds; "it was hidden from hospitals as well."
Some hospital leaders think that having patients wait three to four hours "is horrendous, but in other hospitals, three to four hours is a miracle. In those places, patients may spend two or three days waiting for a bed. There's a terrific spread," Schneider adds.
Schneider believes that when all hospitals are required to report ED wait time data, which will show up on a public database, the extent of that variation will be shocking, indicating widespread problems of resource utilization—such as with radiology or laboratory services—that contribute to patient flow "bottlenecks," she says.
"You're looking at a group of hospitals that volunteered to do this, and are doing it because they think their numbers look good," Schneider says. "The fact that these 74 hospitals are now doing it I think might be a wakeup call for hospitals, [many of whose leaders] may sit around and say, ‘Well, you know, everybody has problems with overcrowding.’ ... They're going to be shocked to find out that five hours is a bad number."
HealthLeaders Media requested comment from hospital officials for a dozen of the hospitals whose ED wait times are now posted on Hospital Compare, including seven of those reporting the longest wait times. One responded.
"Our mission and vision is transparency," says Mary Poole, chief marketing officer for Memorial Hermann Baptist Hospital. "Every time you see data like that, it gives you an opportunity to improve."
According to the CMS final rule that established this voluntary reporting program, the measures "address ED overcrowding ... Reducing the time patients remain in the ED can improve access to treatment and increase the quality of care, and capability of the hospital to provide adequate treatment to patients. ED overcrowding may result in delays in the administration of medication such as antibiotics for pneumonia and has been associated with perceptions of compromised emergency care."
The CMS rule added that "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. Finally, when EDs are overwhelmed, their ability to respond to community emergencies and disasters may be compromised."
CMS said in the rule that it wanted hospitals to perform this exercise voluntarily in order to "identify any needed refinements" prior to required submission with discharged patients as of Jan. 1, 2012.
These two measures are only the first of many more to come, CMS spokesman Don McLeod told HealthLeaders Media in an e-mail response.
The third metric, ED-3, "is a measure of time of arrival to time of departure for discharged patients"—that is, patients who are not admitted as inpatients, hesays. Hospitals will also be required to report "median time from arrival to troponin (a test to determine heart muscle function) results for AMI/chest pain patients; median time from arrival to pain medication for patients with a long bone fracture; and timing from arrival to CT scan results for patients presenting to the ED with symptoms of a stroke." These metrics are part of the outpatient quality reporting program for patient encounters as of Jan. 1, 2012.