1. 2014 Standard Definitions and Metric Goals

2. Consensus Statement Definitions for consistent emergency department metrics were introduced and signed on 7/12/11 by: – American Academy of Emergency Medicine – American Academy of Pediatrics – American Association of Critical-Care Nurses – American College of Emergency Physicians – American Nurses Association – Association of PeriOperative Registered Nurses – Emergency Department Practice Management Association – Emergency Nurses Association – National Association of EMS Physicians (Consensus Statement, ACEP, 2011)

3. 2014 Recommended Performance Metrics Metrics to be reported on monthly Company Report Company Goal - Current New 2014 Main EDs New 2014 Provider Based EDs (FSER) Arrival to Bed1555 Arrival to MSE 25 National Group; 10 American Group10 Bed to MSE1055 Arrival to First Order3015 EMS Offloading555 EMS to AOC10 MSE to DSP (DC)90 70 MSE to ADM Ord.140 DSP to Leave (DC)25 15 % Admissions Held > 60 mins40%35%10% ADM Order to Leave60 ADM LOS240210 DC LOS14012590 Low Acuity LOS85 80 % LPT/LPMSE 1% National Group 0.5% American Group0.5% % AMA 1 % National Group 0.5% American Group0.5% % AMA/LPT/LPMSE 2% National Group 1% American Group1.0%

4. Appendix Metric Definitions

5. Definitions – Time Stamps Emergency Department Arrival Time – The time the patient first arrives at the institution for the purpose of requesting emergency care should be recorded as the arrival time. This is the first contact, and not necessarily registration time or the triage time. – All facilities should be using time clocks at each point of entrance to the ED, and have a well defined process for capturing the actual arrival time. – Some facilities may also be utilizing kiosk to assist in capturing accurate arrival times. (Consensus Statement, ACEP, 2011)

6. Definitions – Time Stamps Emergency Department Offload Time – Time of transfer of the patient from the EMS stretcher to the ED treatment space with assumption of care by ED staff. – This will be measured utilizing Arrival to Bed interval. NOTE: We will be monitoring EMS Arrival to Bed interval and EMS Arrival to Triage interval. (Consensus Statement, ACEP, 2011)

7. Definitions – Time Stamps Emergency Department Transfer of Care from Prehospital Providers – The time care is accepted by hospital staff. – This will be measured utilizing EMS Arrival to Triage interval. NOTE: We will be monitoring EMS Arrival to Bed interval and EMS Arrival to Triage interval. (Consensus Statement, ACEP, 2011)

8. Definitions – Time Stamps Emergency Department Triage Time – The time that rapid or comprehensive triage is initiated by a registered nurse or institutionally credentialed provider. (Consensus Statement, ACEP, 2011)

9. Definitions – Time Stamps Emergency Department Physician / Advanced Practice Registered Nurse (APRN) / Physician Assistant (PA) Contact – The time of first contact of the physician, APRN, or PA (defined as an institutionally credentialed provider) with the patient to initiate the medical screening exam. – This will be measured by Arrival to Greet interval. (Consensus Statement, ACEP, 2011)

10. Definitions – Time Stamps Emergency Department Decision to Admit – The time the ED physician / APRN / PA documents a decision to admit the patient. Documents a decision to admit the patient when the medical screening exam has been completed and stabilizing treatments and interventions have been initiated, diagnostic results needed for admission have been reviewed, and the physician is ready (per hospital process) to initiate the admission process. (Consensus Statement, ACEP, 2011)

11. Definitions – Time Stamps Emergency Department Decision to place in Observation Status – The time the ED physician / APRN / PA documents a decision to place the patient in Observation Status. Documents a decision to place the patient in Observation Status when the medical screening exam has been completed and stabilizing treatments and interventions have been initiated, diagnostic results needed for placement in Observation Status have been reviewed, and the physician is ready (per hospital process) to initiate the process to place in Observation Status. (Consensus Statement, ACEP, 2011)

12. Definitions – Time Stamps Emergency Department Decision to Discharge – The time the ED physician / APRN / PA documents a decision to discharge the patient. Documents a decision to discharge the patient when the medical screening exam has been completed and stabilizing treatments and interventions have been completed, diagnostic results needed for discharge have been reviewed, and the physician is ready (per hospital process) to initiate the discharge process.

13. Definitions – Time Stamps Admission Time – The time the admission order is documented (Consensus Statement, ACEP, 2011)

14. Definitions – Time Stamps Emergency Department Departure Time – The time of physical departure of a patient from the ED treatment space. The time most closely represented by being out of the department and no longer the ED’s responsibility. (Consensus Statement, ACEP, 2011)

15. Definitions – Time Stamps Emergency Department Length of Stay – ED arrival time to ED departure time. (Consensus Statement, ACEP, 2011)

16. Definitions – Time Stamps Admitted Emergency Department Patient – The duration of time a patient remains in the emergency department after the decision to admit the patient to the facility has occurred, but before the patient has been transferred to an inpatient unit. (Consensus Statement, ACEP, 2011)

17. Definitions – Time Stamps Emergency Department Offload Interval – Time of arrival to time of transfer of the patient from the EMS stretcher to the ED treatment space, with assumption of care by ED staff. NOTE: This will be measured from EMS Arrival to Triage (Consensus Statement, ACEP, 2011)