Safety-net hospital EDs perform just as well as other hospital EDs on length-of-stay quality measures, according to a study in JAMA.
For the study, University of California-San Francisco researchers analyzed ED data from the 2008 National Hospital Ambulatory Medical Care Survey regarding LOS targets established by other groups, including four hours for time-to-discharge, transfer, or observation, and eight hours for time-to-admission.
The study found that the median ED LOS for admitted patients was 269 minutes for safety-net EDs, compared with 281 minutes for non-safety-net EDs. Meanwhile, the median ED LOS for discharged patients was 156 minutes for safety-net EDs, compared with 148 minutes for other EDs.
The study may alleviate concerns about potential pay-for-performance measures that some advocates worried would punish safety-net hospitals.
The National Quality Forum in 2008 approved two quality measures for ED LOS that gauge median times from arrival to departure for admitted and discharged patients. Some industry stakeholders had expressed concern that such metrics could negatively affect safety-net hospitals—which care for a disproportionate number of indigent patients—if they were used in pay-for-performance programs.
Despite concerns about the measures, the authors conclude that "both safety-net and non-safety-net EDs perform well on the ED LOS goals that have been proposed," suggesting that similar pay-for-performance metrics would not penalize safety-net institutions (Barr, Modern Healthcare, 1/31 [subscription required]; Nurse.com, 1/31).
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