ER Timeliness Measures May Backfire
(HealthDay News) — While there is room for improvement in the timeliness of emergency department care, pressure to comply with length of stay (LOS) measures may have unintended consequences, according to two research letters published online September 15 in JAMA Internal Medicine.
In the first study, Sidney T. Le and Renee Y. Hsia, MD, from the University of California San Francisco (UCSF), analyzed aggregate hospital-level emergency department measures based on data from the Centers for Medicare & Medicaid Services Hospital Compare database (April 1, 2011, to March 31, 2013). The researchers found that for patients discharged from the emergency department, the median wait time to see a health care professional was approximately half an hour, and the LOS was just over two hours. For admitted patients, the median length of stay in the emergency department was more than four hours, of which one-third of the time was accounted for by boarding time.
The second study, also from UCSF researchers, analyzed data from 24,879 U.S. emergency department visits identified from the 2010 National Hospital Ambulatory Medical Care Survey. The researchers sought to determine whether meeting emergency department LOS targets (four hours for discharged patients and eight hours for patients admitted) was associated with rates of admission. They found that more than half of visits resulting in admission (51.9%) were to hospitals that met the eight-hour target for 90% of admissions. However, among visits resulting in discharge, only 22.5% of visits met the four-hour target for 90% of discharges.
"If the pressure of LOS measures encourages otherwise avoidable inpatient admissions, this could increase health care costs and unnecessary hospital-acquired conditions," write the authors of the second letter. "Policy makers should consider these unintended consequences before adopting emergency department LOS quality measures."