Emergency Department Access

Emergency department (ED) crowding and boarding is increasingly problematic for the US health care system. Research has shown that hospitals with higher levels of crowding and boarding have consistently poorer quality and outcomes (National Quality Forum, 2012). Research has shown that ED wait times are associated with longer length of stays, increased morbidity and mortality, patients leaving the emergency department without being seen, negative patient satisfaction and increased costs (Vermeulen et al., 2014).

There is a growing emphasis on adopting interventions that have proven effective for decreasing ED wait times and crowding. However, research indicates that relatively few hospitals report implementing known strategies for decreasing emergency department wait times (Rabin et al., 2012).

The purpose of this analysis is to identify if there is an association between timely and effective care measures. Specifically, this scenario will answer the following:

  • Do hospitals that have greater wait times also have a higher proportion of patients that leave the ED before being seen?
  • Do hospitals with greater wait times to be seen by a health care practitioner before being admitted to the ED, also those that have higher wait times before ED patients are admitted as an inpatient?

In addition, further analysis will be conducted to determine if these associations exist for counties or states. And finally, the implications of such observed associations will be revealed.

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Tutorial: Using the Data

Data Sources

Hospital Compare - General Hospital Information (data released October 19, 2016)

Hospital Compare - Timely and Effective Care Measures (data released October 19, 2016)

Defining the Columns

A blank entry indicates unreported data. A value of zero is a defined value and does not represent unreported data.

State: The abbreviated name of the state where the hospital is located

County: The name of the county where the hospital is located. County names are listed as provided on the United States Census Bureau's list of 2010 FIPS Codes for Counties and County Equivalient Entities

Hospital: The name of the hospital

Hospital Type: The type of hospital, which includes acute care hospitals, critical access hospitals and children's hospitals

Hospital Ownership: The ownership type for the hospital, which includes: Voluntary non-profit - Private, Government - Federal, Proprietary, Government - Hospital District of Authority, Government - Local, Voluntary non-profit - Other, Voluntary non-profit - Church, Physician, Government - State and Tribal

Measure Name: The name of the timely and effective care measure. The measures include the following:

  • ED_1b: Average time, in minutes, patients spent in the emergency department, before they were admitted to the hospital as an inpatient. A lower value is desired
  • OP_20: Average time, in minutes, patients spent in the emergency department before they were seen by a health care professional. A lower value is desired
  • OP_22: Percentage of patients who left the emergency department before being seen. A lower value is desired

Measure Score: The numeric score for the measure which may represent the average time in minutes or a proportion depending on the measure. See Measure Name for more information on how to interpret the score for each measure. The reporting period for the measures is October 1, 2014 through September 30, 2015

Denominator: The sample size used to determine the score for the measure

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Tutorial: Using Excel Output

The purpose of this presentation is to demonstrate how to conduct analyses to examine the variance in access and timely care measures for specific hospital types, ownership types, states or counties.