The National Quality Forum (NQF) has issued a new set of emergency department performance measures. And not surprising at a time when attention is focused on ED crowding and wait times, 5 of the 10 new measures address throughput, while the remainder look at clinical management protocols.

These measures follow a previous set issued in November 2007 (phase 1) that focused on ED communications and acute myocardial infarction care during ED transfers. Together, they are part of an NQF project to increase public accountability and quality improvement for emergency care. A third set, aimed at prehospital care and care coordination, is envisioned.

As a voluntary consensus standards-setting organization, NQF brought together a steering committee for the project comprising major specialty groups and organizations involved in emergency medicine.

The endorsed measures were selected out of a pool of recommendations submitted by public and private entities.

“All these organizations are interested in process improvement and quality improvement,” said Dr. John Moorhead, an ACEP past president who chaired the NQF steering committee. A professor of emergency medicine at the Oregon Health & Science University School of Medicine, he is a director on the American Board of Emergency Medicine.

“Our hope is that as measures like these get identified, they’re used across the board­—not some measures for one group and some for another,” Dr. Moorhead said.

“We want this to be relevant and done in a way that’s consistent across all the organizations,” he added—whereas if the same groups worked independently to develop performance measures, there would be the risk of redundancy and multiple reporting channels, with attendant burdens on EDs.

‘we want this to be relevant and done in a way that’s consistent across all the organizations.’

Crowding and Wait Times in EDs

Dr. Dennis Beck, chairman of ACEP’s Quality and Performance Committee, said the NQF’s approach is well-considered and points the specialty in a good direction.

“Crowding and boarding problems are among the many challenges facing ACEP and our patients,” he said. “These proposed measures shine a light on a critical problem.”

NQF statistics show that from 1994-2004, ED visits increased by 18%—to 120 million visits a year—while the number of EDs decreased by more than 12%.

In addition to coping with their own capacity problems, EDs “are sometimes forced to shoulder the burden for other hospital departments,” Dr. Beck said.