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  2. CQM-3748

ED-2 Decision to Admit First or Last order. CMS guidance is First order Function statement is Last order in the even of 2 orders

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      Thank you for the question. You are correct there is a discrepancy between the narrative in the measure header guidance and the logic in version 7. The narrative reads “first” documentation and the logic reads “Last” (meaning the most recent). The intent of the measure is to capture the time a decision to admit was made during the ED encounter that is before the patient leaves the ED and prior to an inpatient admission. In order to extract the most recent decision to admit, the operator “Last” is used. Please note that the logic is the source of truth.

      We have corrected this discrepancy in version 8 of this measure for the 2020 reporting period.
      Show
      Thank you for the question. You are correct there is a discrepancy between the narrative in the measure header guidance and the logic in version 7. The narrative reads “first” documentation and the logic reads “Last” (meaning the most recent). The intent of the measure is to capture the time a decision to admit was made during the ED encounter that is before the patient leaves the ED and prior to an inpatient admission. In order to extract the most recent decision to admit, the operator “Last” is used. Please note that the logic is the source of truth. We have corrected this discrepancy in version 8 of this measure for the 2020 reporting period.
    • Median Admit Decision Time to ED Departure Time for Admitted Patients
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      We have 2 admit orders: Bed Request and Admit to. Besides conflicting information, the time difference between the 2 orders can be significant. Our EHR vendor is using the last documented order to calculate the time of Decision to Admit and Depart from ED which is to our benefit. But I need some clarification.
      Show
      We have 2 admit orders: Bed Request and Admit to. Besides conflicting information, the time difference between the 2 orders can be significant. Our EHR vendor is using the last documented order to calculate the time of Decision to Admit and Depart from ED which is to our benefit. But I need some clarification.

      The CMS Guidance states first order:

      Decision to Admit: First documentation of the decision to admit the patient from the ED. Specification: as admission processes vary at different hospitals, this can use the first documented time of any of the following: 1) admission order (this may be an operational order rather than the hospital admission to inpatient status order), 2) disposition order (must explicitly state to admit), 3) documented bed request, or 4) documented acceptance from admitting physician. This is not the "bed assignment time" or "report called time

      Function Statement states Last order.

      Admit Decision(Encounter "Encounter, Performed")

      /Decision to admit order that was during the ED visit that is being referenced/

      Last(["Encounter, Order": "Decision to Admit to Hospital Inpatient"] AdmitOrder

                         where AdmitOrder.authorDatetime during "Related ED Visit"(Encounter).relevantPeriod

                         sort by authorDatetime)

            JLeflore Mathematica EH eCQM Team
            sab104 Stephanie Battista
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