Standards endorsed to boost efficiency, quality
They're voluntary, but CMS could adopt many
The National Quality Forum (NQF) has endorsed 10 national voluntary consensus standards for hospital-based ED care, with the goal of reducing overcrowding, decreasing patient wait time, and improving quality of care. Although the standards are voluntary, experts predict that many, if not most, of the standards ultimately will be adopted by the Centers for Medicare & Medicaid Services (CMS). (See list of measures, left.)
Possibility of implementation
While CMS often ends up adopting standards endorsed by NQF, the likelihood is even greater in this case because CMS actually requested that NQF implement the process that led to this action. "I don't know the answer, but since this was requested and funded by CMS, these are the types of standards they are seeking and there is a much higher likelihood," says Helen Burstin, MD, MPH, NQF's senior vice president of performance measures.
Being endorsed by NQF means those standards have gone through a rigorous process of review. Their approval stamp is important to groups such as CMS that are looking to use measures that have gone through this type of process, says John Moorhead, MD, professor of emergency medicine at Oregon Health & Science University, Portland. Moorhead co-chaired NQF's steering committee on hospital-based ED care. "In fact, CMS had submitted some measures to NQF for review, so we anticipate that those will be adopted, and hopefully all of them will," he says.
"We were able to establish some new clinical measures we think will be helpful to ED physicians as they monitor quality: bundling, documenting wait time, weight in kilograms for kids," says Moorhead. He thinks this will be the beginning of improved reporting on throughput that will more clearly tell the story on crowding in the ED. "Putting some numbers to it will help tell the story to the public, the health care industry, and practicing ED physicians and nurses," he notes.
Understanding factors such as time from arrival to discharge and admit decision time gives providers a broad view of ED care, says Burstin. It also will help the ED in working closely with and coordinating care with other hospitals, she says. "The clinical measures get at high-risk activity like placing endotracheal tubes and ensures we are always looking to document medication for kids based on weight in kilograms," Burstin adds.
Sources
For more information on the new ED standards from National Quality Form, contact:
- Helen Burstin, MD, MPH, Senior Vice President of Performance Measures, National Quality Forum, Washington, DC. Phone: (202) 783-1300. Fax: (202) 783-3434.
- John Moorhead, MD, Professor of Emergency Medicine, Oregon Health & Science University, Portland. Phone: (503) 494-7551.
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