Safety net ERs not at disadvantage on meeting proposed length-of-stay measures, study says

Safety net hospital emergency departments are not at a disadvantage in terms of meeting the terms of proposed length-of-stay measures for patients both admitted and discharged, according to a new study published by the Journal of the American Medical Association.

The authors wrote that there is a concern that performance measures for EDs approved in 2008 by the National Quality Forum could result in safety-net hospitals being harmed if the measures are used in pay-for-performance programs. The fear is that safety net providers—which care for a disproportionate amount of Medicaid and uninsured patients—might be harmed by the two new measures, which look at time to discharge, transfer or held for observation and at time to inpatient admission.

The study compared performance against criteria not in the NQF measures but ones used by other groups: four hours for time-to-discharge, transfer or observation, and eight hours for time-to-admission.

“Our results show that both safety-net and non-safety-net EDs perform well on the ED length-of-stay goals that have been proposed, with median ED lengths of stay for both ED types well under (eight) hours for admissions and under (four) hours for discharges,” the authors wrote.

But both types of hospitals would not do well if the gauge relied on the patient in the 90th percentile of waiting time, which the authors wrote was “particularly concerning” as that measure is often used as a surrogate for crowding.