title: Overall ED efficiency is associated with decreased time to percutaneous coronary intervention for ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Performance of percutaneous coronary intervention (PCI) within 90 minutes of hospital arrival for ST-segment elevation myocardial infarction patients is a commonly cited clinical quality measure. The Centers for Medicare and Medicaid Services use this measure to adjust hospital reimbursement via the Value-Based Purchasing Program. This study investigated the relationship between hospital performance on this quality measure and emergency department (ED) operational efficiency.
  
  
  METHODS
  Hospital-level data from Centers for Medicare and Medicaid Services on PCI quality measure performance was linked to information on operational performance from 272 US EDs obtained from the Emergency Department Benchmarking Alliance annual operations survey. Standard metrics of ED size, acuity, and efficiency were compared across hospitals grouped by performance on the door-to-balloon time quality measure.
  
  
  RESULTS
  Mean hospital performance on the 90-minute arrival to PCI measure was 94.0% (range, 42-100). Among hospitals failing to achieve the door-to-balloon time performance standard, median ED length of stay was 209 minutes, compared with 173 minutes among those hospitals meeting the benchmark standard (P < .001). Similarly, median time from ED patient arrival to physician evaluation was 39 minutes for hospitals below the performance standard and 23 minutes for hospitals at the benchmark standard (P < .001). Markers of ED size and acuity, including annual patient volume, admission rate, and the percentage of patients arriving via ambulance did not vary with door-to-balloon time.
  
  
  CONCLUSIONS
  Better performance on measures associated with ED efficiency is associated with more timely PCI performance.
authors.affiliation: Department of Emergency Medicine, Cooper Medical School of Rowan University, One Cooper Plaza, Suite 152, Camden, NJ 08103. Electronic address: cjones.unc@gmail.com.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Jones
authors.affiliation: Christiana Care Value Institute, Christiana Care Health System, Newark DE.
authors.forename: Seema S
authors.initials: SS
authors.lastname: Sonnad
authors.affiliation: Emergency Department Benchmarking Alliance and the Department of Emergency Medicine, Wright State University, Dayton OH.
authors.forename: James J
authors.initials: JJ
authors.lastname: Augustine
authors.affiliation: Emergency Department Benchmarking Alliance and the Department of Emergency Medicine, Christiana Care Health System, Newark DE.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Reese
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D014487:Centers for Medicare and Medicaid Services, U.S.; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006276:Health Facility Size / Q000706:statistics & numerical data; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014481:United States