America's Emergency Care Environment 2014 Report Card 

This national Report Card rates the overall environment in which the emergency care system operates with a near-failing grade of D+.  For millions of Americans who experience sudden, serious illness or injury every year—and in the increasing scores of communities that must respond to disasters and mass casualty events—immediate access to quality emergency care is essential to saving life and limb. But the availability of that care is threatened by a wide range of factors, including shrinking capacity and an ever-increasing demand for services. Even as more and more Americans come to rely on emergency departments for their acute care needs, particularly aging and sick Boomers and people newly enrolled in Medicaid, such care will increasingly become harder to access. 

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Quality Measurement In The Emergency Department: Past And Future

ABSTRACT: As the United States seeks to improve the value of health care, there is an urgent need to develop quality measurement for emergency departments (EDs). EDs provide 130 million patient visits per year and are involved in half of all hospital admissions. Efforts to measure ED quality are in their infancy, focusing on a small set of conditions and timeliness measures, such as waiting times and length-of-stay. We review the history of ED quality measurement, identify policy levers for implementing performance measures, and propose a measurement agenda. Initial priorities include measures of effective care for serious conditions that are commonly seen in EDs, such as trauma; measures of efficient use of resources, such as high-cost imaging and hospital admission; and measures of diagnostic accuracy. More research is needed to support the development of measures of care coordination and regionalization and the episode cost of ED care. Policy makers can advance quality improvement in ED care by asking ED researchers and organizations to accelerate the development of quality measures of ED care and incorporating the measures into programs that publicly report on quality of care and incentive-based payment systems.

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The Past, Present, and Future of Urgent Matters: Lessons Learned from a Decade of Emergency Department Flow Improvement

ABSTRACT: Over the past decade, emergency departments (ED) have encountered major challenges due to increased crowding and a greater public focus on quality measurement and quality improvement. Responding to these challenges, many EDs have worked to improve their processes and develop new and innovative models of care delivery. Urgent Matters has contributed to ED quality and patient flow improvement by working with hospitals throughout the United States. Recognizing that EDs across the country are struggling with many of the same issues, Urgent Matters—a program funded by the Robert Wood Johnson Foundation (RWJF)—has sought to identify, develop, and disseminate innovative approaches, interventions, and models to improve ED flow and quality. Using a variety of techniques, such as learning networks (collaboratives), national conferences, e-newsletters, webinars, best practices toolkits, and social media, Urgent Matters has served as a thought leader and innovator in ED quality improvement initiatives. The Urgent Matters Seven Success Factors were drawn from the early work done by program participants and propose practical guidelines for implementing and sustaining ED improvement activities.This article chronicles the history, activities, lessons learned, and future of the Urgent Matters program.

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