Center for Health Care Quality, Department of Health Policy, The George Washington University Medical Center, Washington, DC, USA.
Ann Emerg Med. 2012 Jan;59(1):1-10.e2. doi: 10.1016/j.annemergmed.2011.06.013. Epub 2011 Aug 25.
We examine practical aspects of collecting time-based emergency department (ED) performance measures.
Seven measures were implemented in 6 hospitals during 1 year. Structured interviews were used to assess the benefits and burdens of reporting. In 2 hospitals, Centers for Medicare & Medicaid Services (CMS) sample size requirements for 3 measures were compared to a reasonable sample size estimate (in which 95% of samples fell within 15 minutes of the population median).
ED performance data on 29,587 admitted patients and 127,467 discharged patients were reported. Median throughput time for admitted patients ranged from 327 to 663 minutes and for discharged patients ranged from 143 to 311 minutes. Other performance measures varied similarly (2- to 3-fold between hospitals). In general, ED throughput was longer at academic sites and those with higher volume. Several benefits of reporting were identified, including promoting ED quality improvement, accountability, and practice standardization. The burdens included having to access multiple information technology systems and difficulties setting up the data collection. Most respondents found great value in the throughput measures and time to pain medication but less value in time to chest radiograph. The human capital required to implement measures varied by hospital and staff demonstrated a learning curve. Our empirically derived minimum reliable sample sizes were different from CMS recommendations.
There is great variation in performance between EDs in time-based ED measures. There are multiple reporting benefits. Reporting burdens seemed to lessen after data systems were established. The CMS sample size requirements for throughput measures may not be optimal compared with actual ED throughput data.
我们研究了收集基于时间的急诊部（ED）绩效指标的实际方面。
在 1 年内，7 项措施在 6 家医院实施。采用结构化访谈评估报告的收益和负担。在 2 家医院，比较了医疗保险和医疗补助服务中心（CMS）对 3 项措施的样本量要求与合理的样本量估计值（其中 95%的样本落在人口中位数的 15 分钟内）。
报告了 29587 名入院患者和 127467 名出院患者的 ED 绩效数据。入院患者的平均通过时间范围为 327 至 663 分钟，出院患者的平均通过时间范围为 143 至 311 分钟。其他绩效指标的变化也类似（医院间差异为 2 至 3 倍）。一般来说，学术机构和高容量的 ED 吞吐量较长。报告的几个好处包括促进 ED 质量改进、问责制和实践标准化。报告的负担包括必须访问多个信息技术系统和设置数据收集的困难。大多数受访者发现通过时间措施和疼痛药物的时间有很大价值，但对胸部 X 光的时间价值较低。实施措施所需的人力资本因医院而异，员工表现出学习曲线。我们根据经验得出的最小可靠样本量与 CMS 建议不同。
基于时间的 ED 措施中 ED 之间的绩效存在很大差异。报告有多种收益。建立数据系统后，报告负担似乎减轻了。与实际 ED 吞吐量数据相比，CMS 对吞吐量措施的样本量要求可能不是最佳的。
