Reporting information on emergency department crowding to the hospital board and delivery of time-sensitive care.
BACKGROUND
Hospital governing boards influence the quality of care that hospitals provide by holding senior leaders and managers accountable. A study was conducted to determine whether reporting data on emergency department (ED) crowding to hospital boards was associated with better performance on a time-sensitive quality measure for patients with acute myocardial infarction (AMI): Primary PCI [percutaneous intervention] Within 90 Minutes of Hospital Arrival.


METHODS
In a survey, hospital chief quality officers were asked whether the following data were reported to the hospital governing board: ED wait times, the percentage of ED patients who left without being seen (LWBS), and the percentage of admitted ED patients who are boarded in the ED. Responses were paired with Centers for Medicare & Medicaid Services (CMS) data on the percentage of eligible AMI patients who received PCI within 90 minutes of arrival, which served as the hospitals' PCI score.


RESULTS
In the sample of 261 hospitals, 133 (51%) of hospital governing boards received data on wait times, 125 (48%) received data on LWBS, and 63 (24%) received data on ED boarding. After hospital characteristics were controlled for, hospitals that reported data on ED boarding to the governing board had PCI scores that were 5.5 percentage points higher (that is, better); p < .05. There was no association between reporting wait times or LWBS to the board and PCI scores.


CONCLUSIONS
Reporting data on the incidence of ED boarding to hospital governing boards was associated with better performance for PCI. More research is needed to explore the direction of this relationship, but the results suggest that hospitals should consider reporting data on ED boarding to their boards as a low/no-cost quality improvement activity.
Institute for Healthcare Studies, Department of Emergency Medicine, Northwestern University, Chicago, USA. meganmchugh@northwestern.edu
Megan
M
McHugh
Raymond
R
Kang
Alan B
AB
Cohen
Joseph D
JD
Restuccia
Romana
R
Hasnain-Wynia
D003142:Communication; D003441:Crowding; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006075:Governing Board / Q000458:organization & administration; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006801:Humans; D011787:Quality of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D013997:Time Factors; D014850:Waiting Lists