Emergency Department Outpatient Transfer Communication Measure

The Emergency Department (ED) Outpatient Transfer Communication Measure is applicable to a wide range of patients and is NQF endorsed. Pay for Performance and Value Based Purchasing are probable changes on the horizon for Critical Access Hospitals (CAH). Therefore, CAHs need to pro-actively help shape regulated rural-relevant measures that demonstrate improvements in patient care.

Part of this measure is approved in the new CMS outpatient measure, but that does not include the full range of rural relevant activities.

Without significant comments in support it is unlikely that this measure will be adopted. If it is adopted this will set the precedent for measures that speak to the unique nature of rural, in an environment where the focus of reporting outcomes is increasingly important.

Why this measure is relevant to rural and should be included:

 Due to the nature and coordination of care typical in rural settings, this is a great measure of quality.

 It assesses the quality of key patient information communicated from an ED to the referral hospital.

 This is an ideal opportunity to improve nurse and physician hand-offs from the ED to inpatient units, other hospitals and health care facilities, and reduces adverse events.

 Research indicates that seamless communication between the ED and long-term facility is a common challenge for rural providers.

Definition Specifications

The definition of the measure is as follows:  Numerator = Number of information elements sent with transfer patients in seven components  Denominator = All ED patients transferred to another acute facility

Seven components of the measure include every communication touch point and collectively, should improve continuity of care: 1. Pre-transfer: Nurse communication with the receiving hospital and physician communication with receiving physician 2. Patient Identification: Name, address, age, gender, significant others contact, and insurance 3. Vital Signs: Pulse, respiratory rate, blood pressure, oxygen saturation, temperature, glascow score, etc. 4. Medication-related: Medications given, allergies, and medications from home. 5. Administrative or practitioner generated: History and physical, exam, history of current events, chronic conditions, physician orders and plan 6. Nurse Information: Assessment/interventions/response, impairments, catheters, immobilizations, respiratory support, oral limitations, etc. 7. Procedures and Test: Ones performed and results sent

Please contribute to the public comment period through August 31, 2010 to support a rural-relevant measure.

Link to the proposed measure: http://edocket.access.gpo.gov/2010/pdf/2010-16448.pdf - starting on page 46374.