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  2. CQM-5451

ED-2 population inclusion and exclusion

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    • Icon: EH/CAH eCQMs EH/CAH eCQMs
    • Resolution: Answered
    • Icon: Moderate Moderate
    • None
    • None
    • Katrina Houston
    • 951-203-5394
    • The Johns Hopkins Hospital
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      ​Thank you for the inquiry, please see responses below.

      Please assume the following:

      Patient arrives to ED 1/1/22 at 04:00…Inpatient Encounter start date/time = same date/time as decision to admit; patient stay is less than 120 days

      ED Patient with orders for admit to inpatient completed 1/1/22 at 13:00; patient is class of inpatient but physically in ED; Patient elopes from ED; Discharged from ED as ‘eloped’ 1/1/22 at 17:00. Should this patient be included in the population (since orders for admission are complete, but the patient never departed the ED for an inpatient unit)?
      Response: Patient has a decision to admit during the ED encounter and before physically departing the ED and patient was admitted to inpatient status and therefore, would be included in the initial population.

      ED Patient with orders for admit to inpatient completed at 13:00, patient is class of inpatient but in physically in ED; Patient decides to leave AMA at 14:00; Discharge AMA from ED 1/1/22 at 17:00. Should this patient be included in the population?
      Response: Patient has a decision to admit during the ED encounter and before physically departing the ED and patient was admitted to inpatient status and therefore, would be included in the initial population.

      ED Patient with orders for admit to inpatient completed at 13:00. Patient is class of inpatient but physically in ED. At 16:00, Admit orders canceled and an order placed to discharge from ED. Patient discharged to home from ED at 1/1/22 at 16:30. Should this patient be included in the population?
      Response: Since the admission orders for inpatient are cancelled this patient would not be included in the initial population.

      ED Patient with orders for admit to observation completed at 13:00; patient is observation class, but physically in ED; observation orders canceled at 13:30 and orders for admission to inpatient completed at 14:00 (patient is obs class but physically in ED when these orders are written, inpatient class/physically in ED when orders are completed). Patient departs ED for inpatient unit 1/1/22 16:00. Patient arrives inpatient unit 1/1 16:10. Patient discharged from inpatient hospitalization 1/3/22 10:00. Should this patient be included in the ED-2 population, why or why not?
      Response: decision to admit inpatient made during ED encounter and before patient physically departed the ED, if the patient was discharge from ED within an hour of the inpatient admission, the patient would be included in the initial population.

      ED patient with principal diagnosis psychiatric in nature – order for admit to inpatient psych completed 1/1/22 at 13:00. Order changed at 15:00 to transfer to another inpatient psychiatric facility. Patient discharged from ED as transfer to acute psych facility 1/1/22 at 19:00. Should this patient be included in the ED-2 population?
      Response: This patient would not be included in the initial population because he was not admitted inpatient to the inpatient facility where the ED visit occurred.

      ED Patient with orders for admit to inpatient completed 1/1/22 at 13:00; patient is inpatient class but physically in ED. At 16:00 patient departs ED for OR (inpatient class). Patient arrives on inpatient unit from OR following surgery (inpatient class) 1/1/22 at 18:00. Patient is discharged from inpatient unit 1/3/22 at 10:00. Should this patient be included in the ED-2 population?
      Response: if the patient ED discharge was within an hour of the inpatient admission, then the patient would be included in the initial population since he had a decision to admit during the ED and before physically leaving and was admitted inpatient.

      Show
      ​Thank you for the inquiry, please see responses below. Please assume the following: Patient arrives to ED 1/1/22 at 04:00…Inpatient Encounter start date/time = same date/time as decision to admit; patient stay is less than 120 days ED Patient with orders for admit to inpatient completed 1/1/22 at 13:00; patient is class of inpatient but physically in ED; Patient elopes from ED; Discharged from ED as ‘eloped’ 1/1/22 at 17:00. Should this patient be included in the population (since orders for admission are complete, but the patient never departed the ED for an inpatient unit)? Response: Patient has a decision to admit during the ED encounter and before physically departing the ED and patient was admitted to inpatient status and therefore, would be included in the initial population. ED Patient with orders for admit to inpatient completed at 13:00, patient is class of inpatient but in physically in ED; Patient decides to leave AMA at 14:00; Discharge AMA from ED 1/1/22 at 17:00. Should this patient be included in the population? Response: Patient has a decision to admit during the ED encounter and before physically departing the ED and patient was admitted to inpatient status and therefore, would be included in the initial population. ED Patient with orders for admit to inpatient completed at 13:00. Patient is class of inpatient but physically in ED. At 16:00, Admit orders canceled and an order placed to discharge from ED. Patient discharged to home from ED at 1/1/22 at 16:30. Should this patient be included in the population? Response: Since the admission orders for inpatient are cancelled this patient would not be included in the initial population. ED Patient with orders for admit to observation completed at 13:00; patient is observation class, but physically in ED; observation orders canceled at 13:30 and orders for admission to inpatient completed at 14:00 (patient is obs class but physically in ED when these orders are written, inpatient class/physically in ED when orders are completed). Patient departs ED for inpatient unit 1/1/22 16:00. Patient arrives inpatient unit 1/1 16:10. Patient discharged from inpatient hospitalization 1/3/22 10:00. Should this patient be included in the ED-2 population, why or why not? Response: decision to admit inpatient made during ED encounter and before patient physically departed the ED, if the patient was discharge from ED within an hour of the inpatient admission, the patient would be included in the initial population. ED patient with principal diagnosis psychiatric in nature – order for admit to inpatient psych completed 1/1/22 at 13:00. Order changed at 15:00 to transfer to another inpatient psychiatric facility. Patient discharged from ED as transfer to acute psych facility 1/1/22 at 19:00. Should this patient be included in the ED-2 population? Response: This patient would not be included in the initial population because he was not admitted inpatient to the inpatient facility where the ED visit occurred. ED Patient with orders for admit to inpatient completed 1/1/22 at 13:00; patient is inpatient class but physically in ED. At 16:00 patient departs ED for OR (inpatient class). Patient arrives on inpatient unit from OR following surgery (inpatient class) 1/1/22 at 18:00. Patient is discharged from inpatient unit 1/3/22 at 10:00. Should this patient be included in the ED-2 population? Response: if the patient ED discharge was within an hour of the inpatient admission, then the patient would be included in the initial population since he had a decision to admit during the ED and before physically leaving and was admitted inpatient.
    • CMS0111v10
    • Seeking to confirm understanding of measure specifications

      In reference to ONC-JIRA CQM 5395, I’ve added information. Could you please confirm how to handle the following scenarios - specifically, whether the patients should be included in the ED-2 population?:

      Please assume the following:

      Patient arrives to ED 1/1/22 at 04:00…Inpatient Encounter start date/time = same date/time as decision to admit; patient stay is less than 120 days

      • ED Patient with orders for admit to inpatient completed 1/1/22 at 13:00; patient is class of inpatient but physically in ED; Patient elopes from ED; Discharged from ED as ‘eloped’ 1/1/22 at 17:00. Should this patient be included in the population (since orders for admission are complete, but the patient never departed the ED for an inpatient unit)?
      • ED Patient with orders for admit to inpatient completed at 13:00, patient is class of inpatient but in physically in ED; Patient decides to leave AMA at 14:00; Discharge AMA from ED 1/1/22 at 17:00. Should this patient be included in the population?
      • ED Patient with orders for admit to inpatient completed at 13:00. Patient is class of inpatient but physically in ED. At 16:00, Admit orders canceled and an order placed to discharge from ED. Patient discharged to home from ED at 1/1/22 at 16:30. Should this patient be included in the population?
      • ED Patient with orders for admit to observation completed at 13:00; patient is observation class, but physically in ED; observation orders canceled at 13:30 and orders for admission to inpatient completed at 14:00 (patient is obs class but physically in ED when these orders are written, inpatient class/physically in ED when orders are completed). Patient departs ED for inpatient unit 1/1/22 16:00. Patient arrives inpatient unit 1/1 16:10. Patient discharged from inpatient hospitalization 1/3/22 10:00.  Should this patient be included in the ED-2 population, why or why not?
      • ED patient with principal diagnosis psychiatric in nature – order for admit to inpatient psych completed 1/1/22 at 13:00. Order changed at 15:00 to transfer to another inpatient psychiatric facility. Patient discharged from ED as transfer to acute psych facility 1/1/22 at 19:00. Should this patient be included in the ED-2 population?
      • ED Patient with orders for admit to inpatient completed 1/1/22 at 13:00; patient is inpatient class but physically in ED. At 16:00 patient departs ED for OR (inpatient class). Patient arrives on inpatient unit from OR following surgery (inpatient class) 1/1/22 at 18:00. Patient is discharged from inpatient unit 1/3/22 at 10:00. Should this patient be included in the ED-2 population?

      Thank you for providing guidance--

            JLeflore Mathematica EH eCQM Team
            khouston Katrina Houston (Inactive)
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