Letters
Figure 2. High Sensory Distraction Television Shows Encourage Greater Food Intake 300 Female
250
Grams Consumed
Male 200 150
Author Contributions: Drs Tal and Wansink had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: All authors. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Tal. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Tal. Administrative, technical, or material support: Zuckerman, Wansink. Study supervision: Zuckerman, Wansink. Published Online: September 1, 2014. doi:10.1001/jamainternmed.2014.4098. Conflict of Interest Disclosures: None reported.
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Funding/Support: This research was made possible by support from Cornell University.
50 0 Talk Show
Action Movie (No Sound)
Action Movie (Sound)
Bars indicate means; limit lines, 95% CI.
more grams of food (206.5 vs 104.3 g) and 65% more calories (354.1 vs 214.6) than did participants watching Charlie Rose. Even while watching the silent version of The Island, featuring increased camera cuts but no sound, participants ate 36% more grams of food (142.1 vs 104.3 g) and 46% more calories (314.5 vs 214.6) than participants watching Charlie Rose. The difference in amount consumed between groups watching different programs was significant (P 4 hours) before being placed in an inpatient bed. This would create an incentive against boarding, yet would not exert the same pressure to rapidly move all patients through the ED, as a strict overall LOS target does. We need to refocus hospitals on the everyday crisis of lengthy ED waiting and boarding time and discourage them from putting the sickest patients at the back of the line. The studies by Le and Hsia1 and Carrier et al4 bring important attention to ED and hospital crowding—critical barriers to high quality care of acute medical conditions—and raise important concerns around the use of performance measures.1,4 The availability of publicly available quality metrics will allow us to track performance; however, the challenge lies in incentivizing hospitals to improve while watching for unintended consequences.
[published online September 15, 2014]. JAMA Intern Med. doi:10.1001 /jamainternmed.2014.3467. 5. Mason S, Weber EJ, Coster J, Freeman J, Locker T. Time patients spend in the emergency department: England’s 4-hour rule: a case of hitting the target but missing the point? Ann Emerg Med. 2012;59(5):341-349. 6. Litvak E, Bisognano M. More patients, less payment: increasing hospital efficiency in the aftermath of health reform. Health Aff (Millwood). 2011;30(1): 76-80. 7. Viccellio A, Santora C, Singer AJ, Thode HC Jr, Henry MC. The association between transfer of emergency department boarders to inpatient hallways and mortality: a 4-year experience. Ann Emerg Med. 2009;54(4):487-491. doi:10 .1016/j.annemergmed.2009.03.005. 8. McHugh M, Regenstein M, Siegel B. The profitability of Medicare admissions based on source of admission. Acad Emerg Med. 2008;15(10):900-907.
Timeliness of Care in US Emergency Departments: An Analysis of Newly Released Metrics From the Centers for Medicare & Medicaid Services The relationship between increasing emergency department (ED) crowding and worse outcomes for patients has been well documented.1,2 This evidence has created growing recognition among federal policy makers that the quality of emergency care should be measured. In July 2013, the Centers for Medicare & MedRelated article page 1843 and icaid Services3 made several Invited Commentary page 1846 quality measures of ED timeliness publicly available online. These data provide a national portrait of the ability of EDs to provide timely care, an essential concern given the severity and time sensitivity of many acute illnesses and injuries. We investigated how hospital EDs perform on measurements of timely care and whether certain hospital characteristics or patient populations are associated with poor timeliness of ED care. Previous literature on ED timeliness of care has been limited to investigations with non–nationally representative samples or to 1 or 2 measures of timeliness of care.1,4-7 Figure. Distribution of Hospital-Level Means of Emergency Department Measures of Timely Care
Jeremiah D. Schuur, MD, MHS Author Affiliations: Department of Emergency Medicine, Brigham & Women’s Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts. Corresponding Author: Jeremiah D. Schuur, MD, MHS, Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 ([email protected]).
Discharged patients Wait timea Length of stayb Admitted patients Wait timec Length of stayd
Published Online: September 15, 2014. doi:10.1001/jamainternmed.2014.1174. Conflict of Interest Disclosures: None reported. 1. Le ST, Hsia RY. Timeliness of care in US emergency departments: an analysis of newly released metrics from the Centers for Medicare & Medicaid services [published online September 15, 2014]. JAMA Intern Med. doi:10.1001 /jamainternmed.2014.3431. 2. Newton MF, Keirns CC, Cunningham R, Hayward RA, Stanley R. Uninsured adults presenting to US emergency departments: assumptions vs data. JAMA. 2008;300(16):1914-1924. 3. Taubman SL, Allen HL, Wright BJ, Baicker K, Finkelstein AN. Medicaid increases emergency-department use: evidence from Oregon’s health insurance experiment. Science. 2014;343(6168):263-268. 4. Carrier E, Khaldun J, Hsia RY. Association between emergency department length of stay and rates of admission to inpatient and observation services jamainternalmedicine.com
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200
400
600
800
1000
1200
Time, min
The bottom and top of the box represent the 25th and 75th percentiles of the hospital-reported mean times for that measure, with the middle line representing the median. The whiskers represent the minimum and maximum reported values for each measure. a
Time of arrival to time seen by a health care professional.
b
Time of arrival to time being sent home.
c
Time of arrival to time leaving the emergency department for an inpatient bed.
d
Time the physician decides to admit a patient to time the patient leaves the emergency department for an inpatient bed.
JAMA Internal Medicine November 2014 Volume 174, Number 11
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archinte.jamanetwork.com/ by a University of Georgia User on 05/24/2015
1847
Figure 2. High Sensory Distraction Television Shows Encourage Greater Food Intake 300 Female
250
Grams Consumed
Male 200 150
Author Contributions: Drs Tal and Wansink had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: All authors. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Tal. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Tal. Administrative, technical, or material support: Zuckerman, Wansink. Study supervision: Zuckerman, Wansink. Published Online: September 1, 2014. doi:10.1001/jamainternmed.2014.4098. Conflict of Interest Disclosures: None reported.
100
Funding/Support: This research was made possible by support from Cornell University.
50 0 Talk Show
Action Movie (No Sound)
Action Movie (Sound)
Bars indicate means; limit lines, 95% CI.
more grams of food (206.5 vs 104.3 g) and 65% more calories (354.1 vs 214.6) than did participants watching Charlie Rose. Even while watching the silent version of The Island, featuring increased camera cuts but no sound, participants ate 36% more grams of food (142.1 vs 104.3 g) and 46% more calories (314.5 vs 214.6) than participants watching Charlie Rose. The difference in amount consumed between groups watching different programs was significant (P 4 hours) before being placed in an inpatient bed. This would create an incentive against boarding, yet would not exert the same pressure to rapidly move all patients through the ED, as a strict overall LOS target does. We need to refocus hospitals on the everyday crisis of lengthy ED waiting and boarding time and discourage them from putting the sickest patients at the back of the line. The studies by Le and Hsia1 and Carrier et al4 bring important attention to ED and hospital crowding—critical barriers to high quality care of acute medical conditions—and raise important concerns around the use of performance measures.1,4 The availability of publicly available quality metrics will allow us to track performance; however, the challenge lies in incentivizing hospitals to improve while watching for unintended consequences.
[published online September 15, 2014]. JAMA Intern Med. doi:10.1001 /jamainternmed.2014.3467. 5. Mason S, Weber EJ, Coster J, Freeman J, Locker T. Time patients spend in the emergency department: England’s 4-hour rule: a case of hitting the target but missing the point? Ann Emerg Med. 2012;59(5):341-349. 6. Litvak E, Bisognano M. More patients, less payment: increasing hospital efficiency in the aftermath of health reform. Health Aff (Millwood). 2011;30(1): 76-80. 7. Viccellio A, Santora C, Singer AJ, Thode HC Jr, Henry MC. The association between transfer of emergency department boarders to inpatient hallways and mortality: a 4-year experience. Ann Emerg Med. 2009;54(4):487-491. doi:10 .1016/j.annemergmed.2009.03.005. 8. McHugh M, Regenstein M, Siegel B. The profitability of Medicare admissions based on source of admission. Acad Emerg Med. 2008;15(10):900-907.
Timeliness of Care in US Emergency Departments: An Analysis of Newly Released Metrics From the Centers for Medicare & Medicaid Services The relationship between increasing emergency department (ED) crowding and worse outcomes for patients has been well documented.1,2 This evidence has created growing recognition among federal policy makers that the quality of emergency care should be measured. In July 2013, the Centers for Medicare & MedRelated article page 1843 and icaid Services3 made several Invited Commentary page 1846 quality measures of ED timeliness publicly available online. These data provide a national portrait of the ability of EDs to provide timely care, an essential concern given the severity and time sensitivity of many acute illnesses and injuries. We investigated how hospital EDs perform on measurements of timely care and whether certain hospital characteristics or patient populations are associated with poor timeliness of ED care. Previous literature on ED timeliness of care has been limited to investigations with non–nationally representative samples or to 1 or 2 measures of timeliness of care.1,4-7 Figure. Distribution of Hospital-Level Means of Emergency Department Measures of Timely Care
Jeremiah D. Schuur, MD, MHS Author Affiliations: Department of Emergency Medicine, Brigham & Women’s Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts. Corresponding Author: Jeremiah D. Schuur, MD, MHS, Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 ([email protected]).
Discharged patients Wait timea Length of stayb Admitted patients Wait timec Length of stayd
Published Online: September 15, 2014. doi:10.1001/jamainternmed.2014.1174. Conflict of Interest Disclosures: None reported. 1. Le ST, Hsia RY. Timeliness of care in US emergency departments: an analysis of newly released metrics from the Centers for Medicare & Medicaid services [published online September 15, 2014]. JAMA Intern Med. doi:10.1001 /jamainternmed.2014.3431. 2. Newton MF, Keirns CC, Cunningham R, Hayward RA, Stanley R. Uninsured adults presenting to US emergency departments: assumptions vs data. JAMA. 2008;300(16):1914-1924. 3. Taubman SL, Allen HL, Wright BJ, Baicker K, Finkelstein AN. Medicaid increases emergency-department use: evidence from Oregon’s health insurance experiment. Science. 2014;343(6168):263-268. 4. Carrier E, Khaldun J, Hsia RY. Association between emergency department length of stay and rates of admission to inpatient and observation services jamainternalmedicine.com
0
200
400
600
800
1000
1200
Time, min
The bottom and top of the box represent the 25th and 75th percentiles of the hospital-reported mean times for that measure, with the middle line representing the median. The whiskers represent the minimum and maximum reported values for each measure. a
Time of arrival to time seen by a health care professional.
b
Time of arrival to time being sent home.
c
Time of arrival to time leaving the emergency department for an inpatient bed.
d
Time the physician decides to admit a patient to time the patient leaves the emergency department for an inpatient bed.
JAMA Internal Medicine November 2014 Volume 174, Number 11
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archinte.jamanetwork.com/ by a University of Georgia User on 05/24/2015
1847
