Pilot Test of an Emergency Department (ED) Discharge Tool

Forms and Documents

Document Name	Status
Form 8 ED Director Interview Guide Form and Instruction	New
Form 6 EDT Implementer Interview Guide Form and Instruction	New
Form 6 Patient Interview guide Form and Instruction	New
Form 5 EDT Implementers Focus Group Guide Form and Instruction	New
Form 4 Research assistant Focus Group Guide Form and Instruction	New
Form 3 Three-Month Patient Follow-up Questionnaire Form and Instruction	New
Form 2 One-Month Patient Follow-up Telephone Call Form and Instruction	New
Form 1 Emergency Department Discharge Tool (EDT) Form and Instruction	New
OMB SS Part B FINAL.doc Supporting Statement B	2014-02-05
Attachment B - EDT User Guide 2013.12.13.docx Supplementary Document	2014-02-21
OMB SS Part A – FINAL.doc Supporting Statement A	2014-04-09

IC Document Collections

IC ID	Document Title	Status
210538	ED Director Interview Guide Form and Instruction	New
210537	EDT Implementer Interview Guide Form and Instruction	New
210536	Patient Interview guide Form and Instruction	New
210535	EDT Implementers Focus Group Guide Form and Instruction	New
210534	Research assistant Focus Group Guide Form and Instruction	New
210533	Three-Month Patient Follow-up Questionnaire Form and Instruction	New
210532	One-Month Patient Follow-up Telephone Call Form and Instruction	New
210531	Emergency Department Discharge Tool (EDT) Form and Instruction	New

ICR Details

OMB Control No: 0935-0217	ICR Reference No: 201402-0935-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/AHRQ	Agency Tracking No: 21409
Title: Pilot Test of an Emergency Department (ED) Discharge Tool
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/14/2014
	Date Received in OIRA: 02/26/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2016	24 Months From Approved
Responses	2,031	0	0
Time Burden (Hours)	549	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The ultimate aim of this study is to pilot test a discharge tool which has the potential to reduce unnecessary visits to the Emergency Department (ED), reduce healthcare expenditure in the ED, as well as streamline and enhance the quality of care delivered to ED patients. The ED is an important and frequently used setting of care for a large part of the U.S. population. In 2006, there were nearly 120 million ED visits in the U.S., of which only 15.5 million (14.7%) resulted in admission to the hospital or transfer to another hospital. Thus the majority ED visits result in discharge to home. Patients discharged from the ED face significant risk for adverse outcomes, with between 3-5 patients per 100,000 visits experiencing an unexpected death following discharge from the ED. Additionally, a sizable minority of patients return to the ED frequently. Published studies estimate that 4.5% to 8% of patients revisit the ED 4 or more times per year, accounting for 21% to 28% of all ED visits. Internal data from John Hopkins Hospital, AHRQ's contractor for this pilot test, supports these findings with 7% of their patients accounting for 26% of visits to the Johns Hopkins Hospital ED in 2011. Patients who revisit the ED contribute to overcrowding, unnecessary delays in care, dissatisfaction, and avoidable patient harm. ED revisits are also an important contributor to rising health care costs, as ED care is estimated to cost two to five times as much as the same treatment delivered by a primary care physician. Thus it is estimated that eliminating revisits and inappropriate use of EDs could reduce health care spending as much as $32 billion each year. Overall, an effective and efficient ED discharge process would improve the quality of patient care in the ED as well as reduce healthcare costs. To respond to the challenges faced by our nation's EDs and the patients they serve, AHRQ will develop and pilot test a tool to improve the ED discharge process.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: US Code: 42 USC 299 Name of Law: Healthcare Research and Quality Act of 1999

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 52925	08/27/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 4718	01/29/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 8

IC Title	Form No.	Form Name
Patient Interview guide	6	Patient Interview guide
Emergency Department Discharge Tool (EDT)	1	Emergency Department Discharge Tool (EDT)
One-Month Patient Follow-up Telephone Call	2	One-Month Patient Follow-up Telephone Call
Three-Month Patient Follow-up Questionnaire	3	Three-Month Patient Follow-up Questionnaire
Research assistant Focus Group Guide	4	Research assistant Focus Group Guide
EDT Implementers Focus Group Guide	5	EDT Implementers Focus Group Guide
EDT Implementer Interview Guide	6	EDT Implementer Interview Guide
ED Director Interview Guide	8	ED Director Interview Guide

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	2,031	0	3	2,028	0	0
Annual Time Burden (Hours)	549	0	3	546	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection request.

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Annual Cost to Federal Government: $170,956

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/26/2014

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