ER throughput measures unfair to big hospitals

Emergency department (ED) throughput measures endorsed by the National Quality Forum may paint large, urban hospitals in a bad light, according to a study in the Annals of Emergency Medicine published last week. Current emergency measures like wait times and length of stay might favor small, rural hospitals and, therefore, unfairly portray large, urban hospitals because of the complexity of their patient loads or simply because managing flow is harder for them.

"If you take a small, rural emergency department with 10 beds and you compare that head to head with a 100-bed emergency department in an intercity or county hospital, it's really apples and oranges," Jesse Pines, director of the Center for Healthcare Quality at George Washington University and associate professor of emergency medicine and health policy in Washington, D.C., told FierceHealthcare. "Both say 'emergency' on the front door, but the way each hospital operates is very different."

Median wait time was a half an hour (34 minutes). Median length of stay of admitted patients was five hours (244 minutes). Median length of stay for patients who were treated and discharged was more than two hours (132 minutes), and the rate of patients who left without being seen was 1.3 percent.

The study found that factors outside of the hospital's control had a greater effect on wait times than on length of stay or rates for patients leaving without being seen. Exogenous hospital factors, such as case mix, age mix, region and teaching status, all could skew the data.

"It makes it look like these large hospitals are performing badly, but it's misleading," Pines explained. "It might actually be a well-managed hospital, which on the face of it, it might look bad because you're comparing it to a very different business."

Hospital Compare, the public Health & Human Services website, includes unadjusted numbers for ED length of stay.

Pines noted that it's important to have publicly reported unadjusted numbers out there for patients who have to wait a certain amount of time no matter the hospital type, but ideally, those numbers should come with an explanation, accounting for differences in performance.

Although current stratification systems do account for risk, there are many factors that still affect the measure results. Pines calls for a more complex, risk-adjusted stratification system that can compare peer hospitals of similar size, case mix, teaching status, and really compare apples to apples.

For more information:
- check out the study abstract

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