2014 Standard
Definitions and
Metric Goals
Consensus Statement
• Definitions for consistent emergency
department metrics were introduced and
signed on 7/12/11 by:
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American Academy of Emergency Medicine
American Academy of Pediatrics
American Association of Critical-Care Nurses
American College of Emergency Physicians
American Nurses Association
Association of PeriOperative Registered Nurses
Emergency Department Practice Management Association
Emergency Nurses Association
National Association of EMS Physicians
(Consensus Statement, ACEP, 2011)
2014 Recommended Performance Metrics
Company Goal Current
New 2014
New 2014
Main EDs
Provider Based EDs (FSER)
15
25 National Group; 10
American Group
5
5
10
10
Bed to MSE
10
5
5
Arrival to First Order
30
15
15
EMS Offloading
5
5
5
EMS to AOC
10
10
10
MSE to DSP (DC)
90
90
70
MSE to ADM Ord.
140
140
140
DSP to Leave (DC)
25
25
15
40%
35%
10%
ADM Order to Leave
60
60
60
ADM LOS
240
210
210
DC LOS
140
125
90
85
1% National Group
0.5% American Group
1 % National Group
0.5% American Group
2% National Group
1% American Group
85
80
0.5%
0.5%
0.5%
0.5%
1.0%
1.0%
Metrics to be reported on
monthly Company Report
Arrival to Bed
Arrival to MSE
% Admissions Held > 60 mins
Low Acuity LOS
% LPT/LPMSE
% AMA
% AMA/LPT/LPMSE
Appendix
Metric Definitions
Definitions – Time Stamps
• Emergency Department Arrival Time
– The time the patient first arrives at the institution for the purpose of
requesting emergency care should be recorded as the arrival time. This is
the first contact, and not necessarily registration time or the triage time.
– All facilities should be using time clocks at each point of entrance to the
ED, and have a well defined process for capturing the actual arrival time.
– Some facilities may also be utilizing kiosk to assist in capturing accurate
arrival times.
(Consensus Statement, ACEP, 2011)
Definitions – Time Stamps
• Emergency Department Offload Time
– Time of transfer of the patient from the EMS stretcher to the ED
treatment space with assumption of care by ED staff.
– This will be measured utilizing Arrival to Bed interval.
NOTE: We will be monitoring EMS Arrival to Bed interval and EMS Arrival to
Triage interval.
(Consensus Statement, ACEP, 2011)
Definitions – Time Stamps
• Emergency Department Transfer of Care
from Prehospital Providers
– The time care is accepted by hospital staff.
– This will be measured utilizing EMS Arrival to Triage interval.
NOTE: We will be monitoring EMS Arrival to Bed interval and EMS Arrival to
Triage interval.
(Consensus Statement, ACEP, 2011)
Definitions – Time Stamps
• Emergency Department Triage Time
– The time that rapid or comprehensive triage is initiated by a registered
nurse or institutionally credentialed provider.
(Consensus Statement, ACEP, 2011)
Definitions – Time Stamps
• Emergency Department Physician / Advanced
Practice Registered Nurse (APRN) / Physician
Assistant (PA) Contact
– The time of first contact of the physician, APRN, or PA (defined as an
institutionally credentialed provider) with the patient to initiate the
medical screening exam.
– This will be measured by Arrival to Greet interval.
(Consensus Statement, ACEP, 2011)
Definitions – Time Stamps
• Emergency Department Decision to Admit
– The time the ED physician / APRN / PA documents a decision to admit the
patient.
• Documents a decision to admit the patient when the medical screening
exam has been completed and stabilizing treatments and interventions
have been initiated, diagnostic results needed for admission have been
reviewed, and the physician is ready (per hospital process) to initiate the
admission process.
(Consensus Statement, ACEP, 2011)
Definitions – Time Stamps
• Emergency Department Decision to place in
Observation Status
– The time the ED physician / APRN / PA documents a decision to place the
patient in Observation Status.
• Documents a decision to place the patient in Observation Status when
the medical screening exam has been completed and stabilizing
treatments and interventions have been initiated, diagnostic results
needed for placement in Observation Status have been reviewed, and the
physician is ready (per hospital process) to initiate the process to place in
Observation Status.
(Consensus Statement, ACEP, 2011)
Definitions – Time Stamps
• Emergency Department Decision to
Discharge
– The time the ED physician / APRN / PA documents a decision to
discharge the patient.
• Documents a decision to discharge the patient when the medical
screening exam has been completed and stabilizing treatments
and interventions have been completed, diagnostic results
needed for discharge have been reviewed, and the physician is
ready (per hospital process) to initiate the discharge process.
Definitions – Time Stamps
• Admission Time
– The time the admission order is documented
(Consensus Statement, ACEP, 2011)
Definitions – Time Stamps
• Emergency Department Departure Time
– The time of physical departure of a patient from the ED treatment space.
• The time most closely represented by being out of the
department and no longer the ED’s responsibility.
(Consensus Statement, ACEP, 2011)
Definitions – Time Stamps
• Emergency Department Length of Stay
– ED arrival time to ED departure time.
(Consensus Statement, ACEP, 2011)
Definitions – Time Stamps
• Admitted Emergency Department Patient
– The duration of time a patient remains in the emergency department
after the decision to admit the patient to the facility has occurred, but
before the patient has been transferred to an inpatient unit.
(Consensus Statement, ACEP, 2011)
Definitions – Time Stamps
• Emergency Department Offload Interval
– Time of arrival to time of transfer of the patient from the EMS stretcher to
the ED treatment space, with assumption of care by ED staff.
NOTE: This will be measured from EMS Arrival to Triage
(Consensus Statement, ACEP, 2011)