Important data sources and applications of ED measures and how they can impact the practice of emergency medicine

As emergency department leaders, it is critical that emergency physicians understand the national data sources available to improve the local emergency system and the functions of the department. This column will review the most important sources and applications of ED performance measures and how they should impact the practice of emergency medicine, including your personal practice. These critical data elements are important for all emergency physicians as discussions evolve regarding the value of emergency care with hospital leaders, community decision makers, and the designers of the future health system.

ED Performance Focused Data Sources

The Emergency Department Benchmarking Alliance (EDBA), founded in 1994, has 20 years of experience in defining ED performance measures, cohorts, and mechanisms for improving the management of EDs. The EDBA annual data survey produces a small number of well-defined performance measures and descriptive elements of the ED. The alliance now comprises 1,000 EDs from every state, and every volume and acuity, that serve 40 million patients. Emergency physicians can find trends in performance measures related to ED size, flow, acuity, disposition, productivity, use of diagnostic tools, and space utilization.

The Centers for Disease Control and Prevention (CDC) initiated a study in 1992 to investigate the types of patients being served in EDs, their medical characteristics, and the disposition of the patients at the end of the visit. The National Hospital Ambulatory Medical Care Survey (NHAMCS) is a wealth of information on emergency medicine in America. The CDC sampling and analysis process takes some time, so the latest available is the 2010 data report, which is based on a sampling of 34,936 ED patient-care reports from 357 EDs. National population census data are used to estimate utilization of ED services by populations. The survey has almost 20 years of annual data, which have been used to identify important trends for emergency physicians and regulatory leaders.

The surveys collectively report on the success of 50 years of prevention programs to which emergency physicians have made tremendous contributions. There has been little recognition of the success in preventing premature death related to trauma, burns, and cardiac arrest. The surveys make it apparent that prevention is working in the emergency population, with ED visits related to injuries continuing to shrink. These now represent about 29 percent of ED patient encounters.

EDs are serving more high-acuity patients and more patients who are arriving in an ambulance. The combined effects of these trends are that ED visits have increased over 12 years from 369 visits per 1,000 population to 428 per 1,000. There is no indicator that points to decreased utilization of emergency services. The ED population is aging, which is in line with the demographics of the country. The ED visit rate for persons older than 65 is much higher than for those younger than 65. As this population group is going to boom for years, emergency physicians must plan for higher ED volumes and design departments that are friendlier to a senior population.