Associations of Emergency Department Length of Stay With Publicly Reported Quality-of-care Measures

Research output: Research - peer-reviewArticle

Abstract

Objective: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length of stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals. Methods: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare. We included hospitals reporting Hospital Compare timeliness measure of LOS for admitted patients. We used AHA and CMS data to incorporate hospital predictors of interest. We used the method of first differences to test for relationships in the change over time between timeliness measures and six hospital-level measures. Results: The cohort consisted of 2,619 hospitals. Each additional hour of ED LOS was associated with a 0.7% decrease in proportion of patients giving a top satisfaction rating, a 0.7% decrease in proportion of patients who would “definitely recommend” the hospital, and a 6-minute increase in time to pain management for long bone fracture (p < 0.01 for all). A 1-hour increase in ED LOS is associated with a 44% increase in the odds of having an increase in left without being seen (95% confidence interval = 25% to 68%). ED LOS was not associated with hospital readmissions (p = 0.14) or time to percutaneous coronary intervention (p = 0.14). Conclusion: In this longitudinal study of hospitals across the United States, improvements in ED timeliness measures are associated with improvements in the patient experience.

LanguageEnglish (US)
Pages246-250
Number of pages5
JournalAcademic Emergency Medicine
Volume24
Issue number2
DOIs
StatePublished - Feb 1 2017
Externally publishedYes

Fingerprint

Quality of Health Care
Hospital Emergency Service
Length of Stay
Centers for Medicare and Medicaid Services (U.S.)
American Hospital Association
Patient Readmission
National Academies of Science, Engineering, and Medicine (U.S.) Health and Medicine Division
Crowding
Bone Fractures
Percutaneous Coronary Intervention
Pain Management
Patient Safety
Longitudinal Studies
Confidence Intervals
Costs and Cost Analysis
Surveys and Questionnaires

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

@article{99aa2062a7104e87981cec7aa2e622cd,
title = "Associations of Emergency Department Length of Stay With Publicly Reported Quality-of-care Measures",
abstract = "Objective: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length of stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals. Methods: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare. We included hospitals reporting Hospital Compare timeliness measure of LOS for admitted patients. We used AHA and CMS data to incorporate hospital predictors of interest. We used the method of first differences to test for relationships in the change over time between timeliness measures and six hospital-level measures. Results: The cohort consisted of 2,619 hospitals. Each additional hour of ED LOS was associated with a 0.7% decrease in proportion of patients giving a top satisfaction rating, a 0.7% decrease in proportion of patients who would “definitely recommend” the hospital, and a 6-minute increase in time to pain management for long bone fracture (p < 0.01 for all). A 1-hour increase in ED LOS is associated with a 44% increase in the odds of having an increase in left without being seen (95% confidence interval = 25% to 68%). ED LOS was not associated with hospital readmissions (p = 0.14) or time to percutaneous coronary intervention (p = 0.14). Conclusion: In this longitudinal study of hospitals across the United States, improvements in ED timeliness measures are associated with improvements in the patient experience.",
author = "Chang, {Anna Marie} and Amber Lin and Rongwei Fu and McConnell, {K. John} and Benjamin Sun",
year = "2017",
month = "2",
doi = "10.1111/acem.13102",
volume = "24",
pages = "246--250",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Associations of Emergency Department Length of Stay With Publicly Reported Quality-of-care Measures

AU - Chang,Anna Marie

AU - Lin,Amber

AU - Fu,Rongwei

AU - McConnell,K. John

AU - Sun,Benjamin

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Objective: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length of stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals. Methods: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare. We included hospitals reporting Hospital Compare timeliness measure of LOS for admitted patients. We used AHA and CMS data to incorporate hospital predictors of interest. We used the method of first differences to test for relationships in the change over time between timeliness measures and six hospital-level measures. Results: The cohort consisted of 2,619 hospitals. Each additional hour of ED LOS was associated with a 0.7% decrease in proportion of patients giving a top satisfaction rating, a 0.7% decrease in proportion of patients who would “definitely recommend” the hospital, and a 6-minute increase in time to pain management for long bone fracture (p < 0.01 for all). A 1-hour increase in ED LOS is associated with a 44% increase in the odds of having an increase in left without being seen (95% confidence interval = 25% to 68%). ED LOS was not associated with hospital readmissions (p = 0.14) or time to percutaneous coronary intervention (p = 0.14). Conclusion: In this longitudinal study of hospitals across the United States, improvements in ED timeliness measures are associated with improvements in the patient experience.

AB - Objective: The Institute of Medicine identified emergency department (ED) crowding as a critical threat to patient safety. We assess the association between changes in publicly reported ED length of stay (LOS) and changes in quality-of-care measures in a national cohort of hospitals. Methods: Longitudinal analysis of 2012 and 2013 data from the American Hospital Association (AHA) Survey, Center for Medicare and Medicaid Services (CMS) Cost Reports, and CMS Hospital Compare. We included hospitals reporting Hospital Compare timeliness measure of LOS for admitted patients. We used AHA and CMS data to incorporate hospital predictors of interest. We used the method of first differences to test for relationships in the change over time between timeliness measures and six hospital-level measures. Results: The cohort consisted of 2,619 hospitals. Each additional hour of ED LOS was associated with a 0.7% decrease in proportion of patients giving a top satisfaction rating, a 0.7% decrease in proportion of patients who would “definitely recommend” the hospital, and a 6-minute increase in time to pain management for long bone fracture (p < 0.01 for all). A 1-hour increase in ED LOS is associated with a 44% increase in the odds of having an increase in left without being seen (95% confidence interval = 25% to 68%). ED LOS was not associated with hospital readmissions (p = 0.14) or time to percutaneous coronary intervention (p = 0.14). Conclusion: In this longitudinal study of hospitals across the United States, improvements in ED timeliness measures are associated with improvements in the patient experience.

UR - http://www.scopus.com/inward/record.url?scp=85012024659&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85012024659&partnerID=8YFLogxK

U2 - 10.1111/acem.13102

DO - 10.1111/acem.13102

M3 - Article

VL - 24

SP - 246

EP - 250

JO - Academic Emergency Medicine

T2 - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 2

ER -