Managers paying attention to data
In light of the growing trend toward public reporting of performance, an increasing number of ED managers are seeking better ways to track their data, says Mark D. Crockett, MD, FACEP, president of the emergency care division at Picis, an information solutions provider based in Wakefield, MA, and an attending ED physician at Morris (IL) Hospital.
"From my perspective, we have a large number of EDs that report anything from wait times to their latest performance," he says. "We see requests from customers to put those kinds of metrics into our software."
With the growing emphasis on reporting quality performance, "you'd better have data," Crockett says. If you don't understand the data behind your ED's processes, the time to understand them is not after you've been questioned by administration, he says. "You can't say, 'I'll go look into that and see what is going on,'" Crockett says. "You need a ready answer."
This preparation is particularly important for "global" data such as time in the department or door-to-doc time, he says. "It also applies to PQRI [Physician's Quality and Reporting Initiative] measures like time to antibiotics," he says. "And this is tied to better outcomes. It's not just administrators being annoyed for no reason."
Having an automated system to collect such data is becoming a "must" for EDs, says Jon Mark Hirshon, MD, MPH, associate in the department of emergency medicine, department of epidemiology and preventive medicine, the National Study Center for Trauma and EMS in Baltimore. "Personally, I think you need some form of automated system," Hirshon says. "With government requirements for electronic health records going forward, that may allow us to have a more automated system for collecting information."
While the fact that these metrics are reported on publicly by private and government organizations frequently can put other areas of performance in the background, it's important that an ED manager maintain focus on all areas of patient care, cautions Rick Bukata, MD, clinical professor of emergency medicine at the Los Angeles County University of Southern California Medical Center, who recently retired after serving as ED director at San Gabriel (CA) Medical Center for 25 years.
"The emphasis others put on specific measures does not mean we should not concentrate on those things that are not measured," he says. "After all, those measures are very limited. They shouldn't distract us from other things." The real issue, from a medical point of view, is that "all we can really measure is our processes," he says. "We can't measure outcomes."