For example, they are often blamed for long ED stays and delays in inpatient admission that result from shortages of beds or personnel in other hospital departments.

One new measure, in particular, gets at the heart of that boarding function by recording the median time from admit decision to time of departure from the ED for patients admitted to inpatient status. This measure and two additional measures—recording median time from ED arrival to ED departure both for patients admitted to the facility and those discharged from the ED—were originally submitted to NQF for consideration by the Centers for Medicare and Medicaid Services (CMS).

Additional throughput measures would record time of first contact in the ED to being seen by a physician or provider and percent of patients leaving without being seen by a physician.

Although some EDs are already keeping track of this information, Dr. Beck said, “what the measures do is set specifications around when the clock starts and what needs to be measured. This makes it precise.”

Throughput Performance May Become Part of CMS Reporting

At least two of the throughput measures endorsed by NQF are likely to be included in CMS reporting and performance initiatives by 2011 or sooner, according to ACEP’s Director of Quality and Health IT, Angela Franklin.

“Whenever CMS wants to use performance measures, it is required by statute to go through a consensus body [such as NQF],” Ms. Franklin said.

For starters, door-to-departure and decision-to-departure measures for ED patients who are admitted as inpatients have been included in the “Specifications Manual for National Hospital Inpatient Quality Measures” that went online in April 2009 (www.qualitynet.org). They are also expected to be included in proposed Inpatient Prospective Payment System rule published in April 2009.

Following a 60-day comment period, “CMS will have to decide if they want to tie hospital annual payment update to reporting of these two measures,” Ms. Franklin said.

While most signs point that way, some parties, including the American Hospital Association, have argued that hospital EDs have different demands placed on them depending on the communities they serve, and that some sort of risk adjustment should be built into the measures.

Along with the throughput measures, NQF endorsed five measures of clinical care. They include management protocols for severe sepsis and septic shock, confirmation of endotrachael tube placement, and documentation of weight in kilograms for children 13 years old or younger.