[CQM-1781] we would appreciate guidance regarding the updates to ED-1 in the July 2015 eCQM specifications, regarding ED date/time.. Created: 11/18/15 Updated: 06/16/16 Resolved: 05/06/16 |
|
| Status: | Closed |
| Project: | eCQM Issue Tracker |
| Component/s: | Guidance |
| Type: | Implementation Problem | Priority: | Minor |
| Reporter: | Lynn Baldwin (Inactive) | Assignee: | Joelencia Leflore |
| Resolution: | Delivered | Votes: | 0 |
| Labels: | None | ||
| Issue Links: |
|
||||||||||||||||||||||||
| Solution: | The date and time intended to be used to represent the arrival date and time for the mean time from ED Arrival to ED Departure in the Measure Observation is the date and time when the patient arrives at the ED "location" (or department) in the hospital. The date and time intended to be used to represent the departure date time included in the Measure Observation is the date and time when the patient leaves the ED "location" (department) in the hospital. Even if the patient goes to another "location" (department) within that same facility, the date and time when the patient left the ED is the correct time to use. In order to make this clearer, the data elements used in the Measure Observation will be changed to use the QDM attributes called Facility Location Arrival Datetime and Facility Location Departure Datetime. The definitions of these attributes have also been improved in QDM to add clarity. Update to solution March 2016: Because this measure is looking at the median time from ED admit to ED discharge for patients admitted to the facility, the inpatient encounter must be preceded by the ED visit. However, the inpatient admit time may not be synonymous with the ED discharge time. This has been addressed in the 2016 Annual Update for this measure by moving the timing constraint for the ED visit from the Measure Population to the Initial Population. In addition, the ED admission date/time and discharge date/time in the Measure Observation have been updated to ED facility location arrival datetime and ED facility location departure datetime. The ED visit start should be based on arrival to the ED, the timestamp in the EHR that most closely captures the date and time the patient arrives to the ED. The ED visit end should be based on when the patient physically leaves the ED, the timestamp in the EHR that most closely captures the date and time the patient leaves the ED. |
||||||||||||||||||||||||
| Solution Posted On: | |||||||||||||||||||||||||
| Comment Posted On: | |||||||||||||||||||||||||
| Description |
|
We would appreciate guidance regarding the updates to ED-1 in the July 2015 eCQM specifications. More specifically, what dates are intended to be used to represent the ED Visit discharge date time and admission date time included in the Measure Observation section below. Population Criteria •Measure Population = ◦AND: Initial Population •Measure Population Exclusions = ◦None •Measure Observation = ◦Median of: ◾Datetime difference of: ◾"Occurrence A of Encounter, Performed: Emergency Department Visit (discharge datetime)" •Stratifications = ◦Stratification 1 = ◾AND NOT: "Diagnosis, Active: Psychiatric/Mental Health Patient (ordinality: Principal)" starts during "Occurrence A of Encounter, Performed: Emergency Department Visit" ◦Stratification 2 = ◾AND: "Diagnosis, Active: Psychiatric/Mental Health Patient (ordinality: Principal)" starts during "Occurrence A of Encounter, Performed: Emergency Department Visit" As we all know, workflows vary across healthcare organizations, in some cases, a patient seen in the ED that is admitted for inpatient care will have 2 encounters created, one for the ED encounter and one for the Inpatient encounter (2 encounter scenario). In other cases, a single encounter may be used and in this case the patient registration record is updated from an ED to Inpatient encounter type and transferred from the ED location to an acute care nurse unit (single encounter scenario). Example > Single encounter scenario Patient arrives via ambulance to the ED on 11/13/2015 at 0900. In this example, what should be used for Encounter, Performed: Emergency Department Visit (admission datetime)? In comparison to the HIQR chart-abstracted measures, we think of admission dt/tm to mean when the patient was admitted for acute inpatient care, however in these eCQM specifications, this does not appear to be the purpose. In this example, would this be the Arrival Dt/Tm or the time the registration transaction took place and the patient was identified with an ED encounter type? Also in this example, what should be used for Encounter, Performed: Emergency Department Visit (discharge datetime)? As noted above, in a single encounter scenario, there is no discharge transaction that takes place when the patient is moved from ED to Inpatient. In this example, would this be the transaction dt/tm when the encounter type is changed from ED to IP or would this be the transaction dt/tm when the location is changed from ED unit to inpatient unit? A JIRA was logged by another person that is related: https://jira.oncprojectracking.org/browse/CQM-1645?jql=text%20~%20%22departure%22 However the response uses the same terms that were used to define the measure, which does not provide clarity. |
| Comments |
| Comment by Julia Skapik (Inactive) [ 05/06/16 ] |
|
A link between |
| Comment by Julia Skapik (Inactive) [ 05/06/16 ] |
|
A link between |
| Comment by Julia Skapik (Inactive) [ 05/06/16 ] |
|
A link between |
| Comment by Joelencia Leflore [ 03/29/16 ] |
|
Because this measure is looking at the median time from ED admit to ED discharge for patients admitted to the facility, the inpatient encounter must be preceded by the ED visit. However, the inpatient admit time may not be synonymous with the ED discharge time. This has been addressed in the 2016 Annual Update for this measure by moving the timing constraint for the ED visit from the Measure Population to the Initial Population. In addition, the ED admission date/time and discharge date/time in the Measure Observation have been updated to ED facility location arrival datetime and ED facility location departure datetime. |
| Comment by Sadie Spicer (Inactive) [ 03/02/16 ] |
|
It would be very helpful if we could get clarification on this measure. Our system is specifically interested in ED departure time. The measure seems to imply departure is equal to inpatient admission time, which is contrary to the current measure intent and iqr tech spec. Are hospitals able to select alternative time stamps as discrete fields (i.e., off the floor time stamps, transfer to obs time stamps, transfer to cardiac cath) for ED end time? |
| Comment by Lynn Baldwin (Inactive) [ 12/18/15 ] |
|
We are looking for an update on this issue. Thanks |
| Comment by Lynn Baldwin (Inactive) [ 12/08/15 ] |
|
We are looking for an update on this issue. Thanks |