From 1996 to 2006, the annual number of emergency department (ED) visits increased approximately 32% from 90.3 million to 119.2 million, according to the Centers for Disease Control and Prevention. Simultaneously, as the number of patient visits increased, the number of hospital EDs decreased from 4,019 to 3,833, increasing the number of annual visits per ED and contributing to crowding. In 2009, Pennsylvania healthcare facilities reported to the Pennsylvania Patient Safety Authority 1,930 events of complications of procedures or treatments or tests from the ED. Existing and proposed ED measures (e.g., from initial patient presentation to final departure)--specifically those from the Hospital Quality Alliance, the Centers for Medicare and Medicaid Services, the Oklahoma Foundation for Medical Quality, and the National Quality Forum--show that national payment and quality organizations have recognized the importance of standardizing ED performance measures. Facilities can use this data to manage patient access and flow in the ED, to increase patient satisfaction, to improve quality of care, and to optimize patient safety. This article focuses on strategies to increase patient safety and improve quality during the ED visit from the point of patient arrival to the diagnostic evaluation.
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