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Published on: January 18, 2018
Overall ED efficiency is associated with decreased time to percutaneous coronary intervention for ST-segment
Christopher W Jones1, Seema S Sonnad2, James J Augustine3
1Department of Emergency Medicine, Cooper Medical School of Rowan University, One Cooper Plaza, Suite 152, Camden, NJ 08103.
Insights
Hospitals with better emergency department (ED) operational efficiency achieve faster door-to-balloon times for ST-segment elevation myocardial infarction patients. This improved efficiency in the ED correlates with more timely percutaneous coronary intervention (PCI) performance.
Area of Science:
- Cardiology
- Healthcare Operations
- Health Services Research
Background:
- Door-to-balloon time for ST-segment elevation myocardial infarction (STEMI) is a key quality metric.
- Centers for Medicare and Medicaid Services (CMS) use this measure for hospital reimbursement.
- This study examines the link between PCI quality performance and ED operational efficiency.
Purpose of the Study:
- To investigate the relationship between hospital performance on the 90-minute PCI quality measure and ED operational efficiency.
- To determine if ED efficiency metrics correlate with timely STEMI treatment.
Main Methods:
- Linked CMS data on PCI quality to ED operational data from 272 US hospitals.
- Compared ED size, acuity, and efficiency metrics across hospitals grouped by PCI performance.
- Utilized data from the Emergency Department Benchmarking Alliance annual operations survey.
Main Results:
- Hospitals meeting the 90-minute door-to-balloon standard had significantly shorter ED lengths of stay (173 vs. 209 minutes).
- Hospitals meeting the standard also had faster times to physician evaluation (23 vs. 39 minutes).
- ED size and patient acuity metrics did not significantly differ between performance groups.
Conclusions:
- Improved emergency department operational efficiency is associated with better performance on the door-to-balloon time quality measure.
- Efficient ED operations facilitate more timely percutaneous coronary intervention for STEMI patients.
Background:
Performance of percutaneous coronary intervention (PCI) within 90 minutes of hospital arrival for ST-segment elevation myocardial infarction patients is a commonly cited clinical quality measure. The Centers for Medicare and Medicaid Services use this measure to adjust hospital reimbursement via the Value-Based Purchasing Program. This study investigated the relationship between hospital performance on this quality measure and emergency department (ED) operational efficiency.
Methods:
Hospital-level data from Centers for Medicare and Medicaid Services on PCI quality measure performance was linked to information on operational performance from 272 US EDs obtained from the Emergency Department Benchmarking Alliance annual operations survey. Standard metrics of ED size, acuity, and efficiency were compared across hospitals grouped by performance on the door-to-balloon time quality measure.
Results:
Mean hospital performance on the 90-minute arrival to PCI measure was 94.0% (range, 42-100). Among hospitals failing to achieve the door-to-balloon time performance standard, median ED length of stay was 209 minutes, compared with 173 minutes among those hospitals meeting the benchmark standard (P < .001). Similarly, median time from ED patient arrival to physician evaluation was 39 minutes for hospitals below the performance standard and 23 minutes for hospitals at the benchmark standard (P < .001). Markers of ED size and acuity, including annual patient volume, admission rate, and the percentage of patients arriving via ambulance did not vary with door-to-balloon time.
Conclusion:
Better performance on measures associated with ED efficiency is associated with more timely PCI performance.
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