Decision to Admit Date (v2021B2)

Specifications Manual for Joint Commission National Quality Measures (v2021B2)

Posted: 9/29/2021

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Release Notes:
Data Element
Version 2021B2

Name:

Decision to Admit Date

Collected For:

ED-2

Definition:

The documented date the decision to admit to observation or inpatient status occurred. Decision to admit to observation or inpatient status date is the date the physician/APN/PA makes the decision to admit the patient from the emergency department to the hospital for continued care in the facility.

Question:

What was the earliest documented month, day, and year of the decision to admit?

Format:

Length:	10 — MM-DD-YYYY (includes dashes) or UTD
Type:	Date
Occurs:	1

Allowable Values:

Enter the earliest documented date of the decision to admit

MM = Month (01-12)
DD = Day (01-31)
YYYY = Year (20xx)
UTD = Unable to Determine

Notes for Abstraction:

If the date of the decision to admit to observation or inpatient status is unable to be determined from medical record documentation, select “UTD.”
The medical record must be abstracted as documented (taken at “face value”). When the date documented is obviously in error (not a valid format/range or outside of the parameters of care [after the Discharge Date]) and no other documentation is found that provides this information, the abstractor should select “UTD.”
Examples:
- Documentation indicates the Decision to Admit Date was 03- 42 -20xx. No other documentation in the list of ONLY ACCEPTABLE SOURCES provides a valid date. Since the Decision to Admit Date is outside of the range listed in the Allowable Values for “Day,” it is not a valid date and the abstractor should select “UTD.”
- Patient expires on 02-12-20xx and all documentation within the ONLY ACCEPTABLE SOURCES indicates the Decision to Admit Date was 03-12-20xx. Other documentation in the medical record supports the date of death as being accurate. Since the Decision to Admit Date is after the Discharge Date (death), it is outside of the parameter of care and the abstractor should select “UTD.”
- When reviewing ED records do NOT include any documentation from external sources (e.g., ambulance records, physician/advanced practice nurse/physician assistant [physician/APN/PA] office record, laboratory reports or ECGs) obtained prior to arrival. The intent is to utilize any documentation that reflects processes that occurred in the ED or hospital.
For purposes of this data element, the source “Emergency Department record” includes any documentation from the time of ED arrival to the time the patient physically departed from the ED.
Example:
ED departure is at 11:00 on 03-12-20xx. The attending physicians admit orders written in the inpatient record at 10:00 on 03-12-20xx are considered part of the ED record.
Disregard physician/APN/PA narrative documentation of a consult or orders for consult, transfer to another physician’s service, or discussion with another physician since this does not reflect a decision was made.
If there is more than one date of documentation for the decision to admit, use the following order to determine which date to abstract.
1.Specified date the decision to admit was documented.
2.Specified date the decision to admit was documented in a non-narrative location (e.g., flowsheet, checklist, screening).
3.Note opened date for the decision to admit documented in a non-narrative location without a specified date (e.g., flowsheet, checklist, screening).
4.Note opened date for narrative documentation identifying the decision to admit was made without a specified date.
Decision to Admit Date includes physician/APN/PA documentation of a decision to send the patient to cath lab or surgery.
Example:
The ED physician documents that he/she is sending the patient to the OR for surgery. The decision to admit to observation or inpatient status date will abstract as the date this was documented.
Use the date from the earliest documentation of decision to admit for either observation or inpatient.
Example:
The physician ordered “Admit Observation Service.” Four hours later the physician wrote an order to admit the patient to inpatient status. These orders were written while the patient was still receiving care in the ED. Use the earlier order for Observation Services to abstract as date and time.
If it can be determined that the patient arrived on the same date and departed on the same date, the arrival date can be used as the decision to admit to observation or inpatient status date.
Data fields representing ‘decision to admit’ in electronic documentation for this specific episode of care are acceptable to use as long as they are the earliestphysician/APN/PA documentation and clearly defined to capture the date an observation status or inpatient admit decision was documented. Information found in an electronically interfaced event log or Admit/Decision/Transfer (ADT) is acceptable provided this information is part of the submitted medical record covering the arrival to discharge date being abstracted.
Examples:
- Decision to Admit
- Dispo
- Disposition set to admit
For purposes of this data element Decision to Admit Date is the date on which the physician/APN/PA makes the decision to admit the patient from the emergency department to the hospital. This will not necessarily coincide with the date the patient is officially admitted to inpatient status.
If the decision to admit the patient to observation or inpatient status is made, but the actual request for a bed is delayed until an inpatient bed is available, record the date the physician/APN/PA communicated the decision to admit.
If the decision to admit to observation or inpatient status date is dated prior to the date of patient arrival or after the date of departure, select “UTD.”
For documentation of a decision to admit accompanied by an indicator, the examples below should be used. Documentation containing a positive indicator should be used for a decision to admit, documentation containing a negative indicator should not be used for a decision to admit.
- Positive Indicators
  - Plan to admit
  - Doctors accepts admission
  - Plan to hospitalize
  - Admit to doctor
  - Need to admit
- Negative Indicators
  - Request admission
  - May need admission
  - Doctor will accept patient
  - Recommend admission
  - Would like to admit

Suggested Data Sources:

Only Acceptable Sources
Emergency Department Record

Additional Notes:

Guidelines for Abstraction:

Inclusion	Exclusion
Admit Order Date Disposition Date	Bed assignment Date Direct admit patients seen in the ED

Specifications Manual for Joint Commission National Quality Measures (v2021B2)
Discharges 10-1-21 through 12-31-21 (4Q21)

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