Att. Q. Emergency Dept. Instructions

Form Approved: OMB No. 0920-0278
U.S. DEPARTMENT OF COMMERCE

NHAMCS-122
(10/2008)

Economics and Statistics Administration

U.S. CENSUS BUREAU
ACTING AS DATA COLLECTION AGENT FOR THE

NATIONAL CENTER FOR HEALTH STATISTICS
CENTERS FOR DISEASE CONTROL AND PREVENTION

2009 NATIONAL HOSPITAL AMBULATORY MEDICAL CARE
SURVEY

Emergency Service Area
Instruction Booklet

Reporting Period
Data Collection Begins:

Data Collection Ends:

On the first day of data collection, begin completing Patient Record forms with the
_____ patient listed on the log for that day.
Select every _____ patient listed on the log during the rest of the reporting period.

Table of Contents
Page
SECTION I

IDENTIFICATION AND GENERAL INSTRUCTIONS/INFORMATION ...... 1

SECTION II

INTRODUCTION................................................................................................ 2
Purpose and Background...................................................................................... 2
Scope .................................................................................................................... 2
Study Roles........................................................................................................... 3
Data Uses.............................................................................................................. 3
Authorization and Assurance of Confidentiality................................................... 4
NHAMCS Participant Web Page ......................................................................... 4

SECTION III

SAMPLING ......................................................................................................... 4
Overview .............................................................................................................. 4
Listing Patient Visits ............................................................................................ 5
Eligible Visits ....................................................................................................... 5
Sampling Procedures ............................................................................................ 6

SECTION IV

COMPLETING PATIENT RECORD FORMS ................................................... 6
Organizing Visit Sampling and Data Collection................................................... 6
Completing the Patient Record Form ................................................................... 7
Item-by-Item Instructions and Definitions for Completing the
ED Patient Record Form ...................................................................................... 9

EXHIBIT A

ENDORSEMENT LETTER FROM THE ACEP .............................................E-1

EXHIBIT B

ENDORSEMENT LETTER FROM THE SAEM ............................................E-2

EXHIBIT C

ENDORSEMENT LETTER FROM THE ENA ...............................................E-3

EXHIBIT D

ENDORSEMENT LETTER FROM THE ACOEP ..........................................E-4

EXHIBIT E

ENDORSEMENT LETTER FROM THE SURGEON
GENERAL’S OFFICE ......................................................................................E-5

EXHIBIT F

ENDORSEMENT LETTER FROM THE FEDERATION OF
AMERICAN HOSPITALS ...............................................................................E-6

EXHIBIT G

ILLUSTRATIVE USES OF NHAMCS ED DATA..........................................E-7

EXHIBIT H

OPTIONAL PATIENT LOG FORM (EXAMPLE)..........................................E-8

EXHIBIT I

ED PATIENT RECORD FORM.......................................................................E-9

EXHIBIT J

NHAMCS Participant Web Page www.cdc.gov/nhamcs ...............................E-10

SECTION I

IDENTIFICATION AND GENERAL INSTRUCTIONS/INFORMATION

A.

Emergency service area name or description

B.

Sampling

C.

1.

LISTING PATIENT VISITS - Keep daily lists of all patient visits beginning at midnight on the
first date of the reporting period (provided on the cover of this booklet) and continuing through
the last date of the reporting period (also provided on the cover). For additional information on
how and who to list, refer to page 5 - "Listing Patient Visits" and "Eligible Visits".

2.

SELECTION OF PATIENT VISITS - Select a sample of patient visits following the
instructions on the cover of this booklet. (See page 6 - "Sampling Procedures" for additional
information on sampling patient visits.)

Patient Record Form Numbers
1.

Folio Number:

3
Additional Folio Number:

3

D.

2.

Contact the field representative when additional pads of Patient Record forms are needed.
DO NOT USE A PAD THAT HAS BEEN ASSIGNED TO ANOTHER UNIT.

3.

Check the Patient Record forms to make sure that they are olive green.

4.

Instructions - General instructions for completing Patient Record forms are on
page 7. Instructions for the individual items begin on page 9. Job Aids for completing the
Patient Record forms are found in the NHAMCS-250, Job Aid Booklet

Field Representative Information

E.

Other Contact

Name

Name

Phone Number

Phone Number

1

SECTION II

INTRODUCTION

Purpose and Background
Every year in the United States, there are approximately 235 million visits made to hospital emergency and
outpatient departments, and hospital-based ambulatory surgery centers. However, adequate data on the
hospital component of ambulatory medical care did not exist until the initiation of the National Hospital
Ambulatory Medical Care Survey (NHAMCS) by the Centers for Disease Control and Prevention’s (CDC)
National Center for Health Statistics (NCHS) in December 1991. This study is the principal source of
information on the utilization of hospital emergency departments (EDs), outpatient departments (OPDs),
and hospital-based ambulatory surgery centers (ASCs) which were added to NHAMCS in 2009.
Moreover, it is the only source of nationally representative estimates on the demographic characteristics of
outpatients, diagnoses, diagnostic services, medication therapy, and the patterns of use of emergency and
outpatient services in hospitals which differ in size, location, and ownership. Data collected through this
study are essential to plan health services, improve medical education, and determine health care workforce
needs.
The study of hospital-based ambulatory care is one of several health care studies sponsored by the CDC’s
National Center for Health Statistics. The National Hospital Ambulatory Medical Care Survey
complements the National Ambulatory Medical Care Survey, which collects data on patient visits to
physicians in office-based practices. The hospital study is now bridging the gap which existed in coverage
of ambulatory care data and is further expanding its uses. This need is further accentuated by the
increasing efforts at cost containment, the rapidly aging population, the growing number of persons
without health insurance, and the introduction of new technologies. The American College of Emergency
Physicians, Society for Academic Emergency Medicine, Emergency Nurses Association, American
College of Osteopathic Emergency Physicians, Surgeon General’s Office, and Federation of American
Hospitals have endorsed this study. (Letters of Endorsement are provided in EXHIBITS A, B, C, D, E,
and F on pages E-1 to E-6.)

Scope
An annual sample of approximately 480 hospitals across the country is selected for participation in the
National Hospital Ambulatory Medical Care Survey. Each hospital collects data for a specified 4-week
period in the survey year. These hospitals are revisited in subsequent years to measure changes in the
public's use of ambulatory medical care services from year to year. Eligible hospitals consist of nonfederal, short-stay, and general hospitals with emergency service areas and/or outpatient clinics and/or
ambulatory surgery centers.
The study includes a sample of ambulatory units, that is, emergency service areas, outpatient clinics, and
ambulatory surgery centers, within each hospital. Medical care must be provided by or under the direct
supervision of a physician for the unit to be considered eligible. Dental clinics, physical therapy, and other
clinics where physician services are not typically provided are not included. Ancillary services, such as
pharmacy, diagnostic x-ray or radiation therapy are also excluded from the study. Private practice offices
and facilities that might have some association with the hospital, but are not considered hospital clinics are
ineligible.

2

Study Roles
The National Center for Health Statistics has contracted with the U.S. Census Bureau to implement the
data collection activities for the National Hospital Ambulatory Medical Care Survey. Trained Census
Bureau field representatives will:
♦

contact selected hospitals to screen them for eligibility and arrange an appointment with the
hospital administrator or other designated representative to further discuss the study;

♦

assist the hospital as requested in obtaining the necessary approval for participation in the study;

♦

obtain basic information on the hospital's emergency and outpatient departments and
ambulatory surgery centers and select the ambulatory care units to be included in the data
collection;

♦

show hospital staff how to select a sample of patient visits and record the data; and

♦

monitor the data collection procedures during the reporting period.

We are asking the hospital staff to do the following two activities:
♦

select a sample of patient visits during a specific 4-week reporting period following the specific
sampling guidelines provided; and

♦

complete a one-page form for each selected visit.

A Census Bureau field representative will visit each week to resolve any problems with sampling patient
visits or completing Patient Record Forms, and to collect any forms already completed. If any problems
arise, or assistance is otherwise needed between these weekly visits, contact the field representative or
other contact (as listed in items D and E on page 1) immediately.

Data Uses
As mentioned earlier, the information collected on patient visits to hospital emergency and outpatient
departments and ambulatory surgery centers through the National Hospital Ambulatory Medical Care
Survey will complement the study of physician office-based ambulatory care. The uses of ED data are
shown in EXHIBIT G on page E-7. The list of data users is quite extensive and includes medical
associations, universities and medical schools, government agencies, broadcast and print media, and
advocacy groups.

3

Authorization and Assurance of Confidentiality
The National Center for Health Statistics has authority to collect data concerning the public's use of
physicians' services under Section 306 (b) (1) (F) of the Public Health Service Act (42 USC 242k).
Any identifiable information will be held confidential and will only be used by NCHS staff, contractors, or
agents, only when necessary and with strict controls, and will not be disclosed to anyone else without the
consent of your hospital. By law, every employee as well as every agent has taken an oath and is subject to
a jail term of up to five years, a fine up to $250,000, or both if he or she willfully discloses ANY
identifiable information about your hospital’s patients. Furthermore, the names or any other identifying
information for individual patients are never collected. Assurance of confidentiality is provided to all
respondents according to Section 308 (d) of the Public Health Service Act (42 USC 242m).
The requirements of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule on
health information permits the hospital to make disclosures of protected health information without patient
authorization for (1) public health purposes, or (2) research that has been approved by an Institutional
Review Board, or (3) under a data use agreement with NCHS. There are several things that you must do to
assure compliance with the Privacy Rule including providing a privacy notice to your patients that
indicates that patient information may be disclosed for either research or public health purposes, and a
record that a disclosure of information to CDC for the NHAMCS was made. More specific information
can be obtained about Privacy Rule disclosure requirements on our website mentioned below.
NHAMCS Participant Web Page
The National Center for Health Statistics has a web page devoted to the common questions and concerns of
hospital staff participating in the National Hospital Ambulatory Medical Care Survey. The participant web
site can be accessed by logging on to www.cdc.gov/nhamcs. Refer to EXHIBIT J on page E-10 for the
table of contents.

SECTION III

SAMPLING

Overview
The hospitals, EDs, and visits chosen for the study are selected by well-established statistical methods.
The sample design is comprised of multiple stages to ensure that the sample of hospitals, EDs, and visits
selected are representative of those throughout the United States. The participation of each hospital is
crucial, since each hospital in the sample represents many others in the country. In each emergency service
area, a sample of patient visits is chosen.
Keeping respondent burden and survey costs as low as possible are always important considerations when
designing a study. Sampling allows us to make national estimates of the volume and characteristics of
patient visits from a small sample of visits to EDs and hospitals, while reducing both the cost of the study
and the work asked of the hospital staff. However, sampling procedures must be implemented accurately
or large errors will result, adversely affecting the data. The National Center for Health Statistics selects the
hospitals to be used for the study. The responsibility for sampling patient visits within the emergency
service areas lies with the hospital staff. Procedures for selecting patient visits have been designed to be
simple and easy to implement. Census Bureau field representatives will instruct the hospital staff on these
procedures.
4

Patient visits are systematically selected over the 4-week reporting period. The sampling procedures are
designed so that on average, approximately 100 visits are selected from the emergency department. The
sampled visits are spread over the emergency department, if the hospital has multiple emergency service
areas. The number of visits sampled for each emergency service area is dependent on the area’s patient
volume.
Listing Patient Visits
A daily listing of all patient visits must be kept or constructed by each participating unit so that a sample of
visits can be selected using the prescribed methods. The list of patient visits may be taken from an arrival
log or other source of recording patient visits. The order in which the patients are listed is not important.
However, it is crucial to have a complete listing of all patients receiving treatment during all hours of
operation. The list should include those patients who came without previously being scheduled, but it
should exclude persons who canceled appointments or were "no shows." The Census Bureau field
representative will review the method used for listing patient visits (or constructing patient lists) in each
unit to determine if patient sampling can be done properly. In some instances, the Census Bureau field
representative will provide an Optional Patient Log (EXHIBIT H on page E-8) to assist the ambulatory
unit with visit sampling.
Once visit sampling begins, the order of the names must not change. Sampling procedures require that
each visit be selected at a predetermined interval (for example, every 2nd patient, every 10th patient, every
15th patient, etc.). This is the "Take Every" pattern. If a patient is inserted into the list after sampling has
already been done, the pattern will be off and the visits must be resampled.

Eligible Visits
A "visit" is defined as a direct, personal exchange between an ambulatory patient and a physician, or a staff
member acting under the direct supervision of a physician, for the purpose of seeking care and rendering
health services. Visits solely for administrative purposes and visits in which no medical care is provided
are not eligible. The following are types of visits/contacts which should be excluded:
♦

persons who visit only to leave a specimen, pick up a prescription or medication, or other visit
where medical care is not provided;

♦

persons who visit to pay a bill, complete insurance forms, or for some other administrative
reason;

♦

telephone calls or e-mail messages from patients;

♦

visits by persons currently admitted as inpatients to any other health care facility on the
premises, that is, the sample hospital.

5

It may be helpful to provide a brief reason for the patient's visit on the patient visit list/log to ensure the
exclusion of these types of visits from the sample. If you discover that an ineligible visit has been
accidentally included in the sample and a Patient Record form completed, write "VOID" in the white space
of the top margin of the Patient Record form to the right of the “Incorrect” box. Do NOT write “VOID”
ACROSS the Patient Record form for any reason.
Sampling Procedures
The 4-week reporting period for this unit is recorded on the cover of this booklet. It includes the date for
beginning data collection, as well as the date for completing data collection. To determine which patient
visit to sample first, refer to the instructions at the bottom of this booklet's cover. The first part of the
instruction directs staff to start with the patient listed on a specific line number of the log on the first day
of data collection. Locate this patient visit on the list and mark the name to indicate that it is the first
patient visit sampled.
To continue sampling, refer once again to the instructions on the cover. Select every nth patient.
Continue counting down the patient list until you arrive at the nth patient name listed. This is the second
patient selected for the sample. This process is repeated to select subsequent patient visits for the sample.
For example, if the sampling instructions indicate that you begin with the 3rd patient listed, and select
every 15th patient, you would select the 3rd, 18th, 33rd and so forth. See EXHIBIT H (page E-8) for an
Optional Patient Log marked with an example of a sampling pattern. Be sure to follow the sampling
pattern given on the cover of this booklet.
After each selection, mark or circle the patient name to indicate its inclusion in the sample, and to indicate
where to begin sampling the next patient visit. The “Take Every” pattern remains consistent throughout
the remainder of the reporting period and should be followed continuously (from shift to shift, and day to
day). Do not start fresh with a new "Start With" after the end of a shift or day.

SECTION IV

COMPLETING PATIENT RECORD FORMS

Organizing Visit Sampling and Data Collection
A Patient Record form is completed for every patient visit selected in the sample during the 4-week
reporting period. The ED Patient Record form is a single paged two-sided form consisting of 14 items
which require only short answers. It should take approximately seven minutes to complete each form.
These forms will require even less time to complete as staff become more familiar with the items. The
sampling procedures are designed so that an emergency department of average size will complete
approximately 100 Patient Record forms during the reporting period. If multiple emergency service areas
exist within the emergency department, fewer forms will be completed in each emergency service area with
the total department completing 100 forms.

6

The Patient Record forms may be completed either during the patient's visit, immediately after the patient's
visit, at the end of the shift, day, etc., or in some combination of these, whichever is most convenient for
the staff. In some cases, a nurse or clerk may furnish the information for certain items prior to the patient's
visit, leaving the remainder of the items to be completed by the health care provider during or immediately
after the visit. In other situations, it may be more convenient to complete all records at the end of the shift
or day by one designated person. Whatever method you choose, it is strongly suggested that the forms be
completed at least on a daily basis. Retrieving the records at a later date may prove to be difficult and
time-consuming. Also, patient information will be fresher in the minds of the staff in case clarification is
needed.
Staff members completing Patient Record forms must be familiar with medical terms and procedures since
most items on the form are clinical in nature. They must also know where to locate the information
necessary for completing the forms. To ensure that complete coverage is provided for all shifts and days,
the responsibility for data collection may require the participation of several staff. We ask that each
participating emergency service area appoint a Data Coordinator to coordinate the personnel involved in
the study and their activities. The Data Coordinator's responsibilities will include supervising and/or
conducting the selection of the sample visits and the completion of the Patient Record forms.
Prior to the emergency service area's assigned reporting period, the Census Bureau field representative will
meet with the director of each emergency service area and discuss the organization of sampling and the
process of completing the Patient Record forms. The director then determines which staff will be needed
in the data collection activities. The Census Bureau field representative will train the staff on sampling
and data collection.
Completing the Patient Record Form
The ED Patient Record form consists of two sections separated by a perforated line. (See EXHIBIT I on
page E-9 for an example of the Patient Record form.) The top section of the form contains two items of
identifying information about the patient - the patient's name and the patient’s medical record number. It is
helpful to enter the information for these items immediately following the selection of the patient visit into
the sample. The top section of the form remains attached to the bottom until the entire form is completed.
To ensure patient confidentiality, hospital staff should detach and keep the top section before the Patient
Record forms are collected by the Census Bureau field representative. The Data Coordinator should keep
this portion of the form for a period of four weeks following the reporting period. Should the field
representative discover missing or unclear information while editing the forms, he or she may recontact the
Data Coordinator to retrieve this information. The top section can be matched to the bottom by the sevendigit identification number (beginning with 3) printed on both sections of the form. The field
representative will give you this identification number when requesting information.
The bottom section of the ED form consists of 14 items designed to collect data on the patient's
demographic characteristics, reason for visit, diagnosis, etc. Item-by-item instructions begin on page 8 of
this instruction booklet. To ensure patient confidentiality, please do not record any patient-identifying
information on the bottom portion of the form.

7

Each emergency service area receives a folio containing a pad of Patient Record forms specifically
assigned to that area. An ample supply of forms is included in the event that some are damaged or
destroyed or the unit sees a much higher volume of patient visits than expected. Should the supply of
forms for this emergency service area run low, please contact the Census Bureau field representative or
other contact provided in items D and E on page 1 of this booklet. Do not borrow Patient Record forms
from other participating emergency service areas or from outpatient department clinics or
ambulatory surgery centers in this hospital. Check the Patient Record forms to make sure that they
are shaded in olive green and have "Emergency Department" printed at the top.

8

Item-by-Item Instructions and Definitions for Completing the ED Patient Record Form

1.

PATIENT INFORMATION

ITEM 1a.

DATE AND TIME OF VISIT

(1) Arrival – Record the month, day, and 2-digit year of arrival in figures, for example, 05/17/09 for
May 17, 2009. Record the hour and minutes when the patient first arrived. For example, enter
01:15 for 1:15 a.m. or 1:15 p.m. and check the appropriate box (a.m. or p.m. or Military). Enter the
first time listed in the medical record (i.e., arrival/registration/triage).
(2) Seen by MD/DO/PA/NP – Record the month, day, and 2-digit year the patient was first seen by a
physician, physician assistant, or nurse practitioner in figures, for example, 05/17/09 for May 17,
2009. Record the hour and minutes when the patient was first seen first by a physician, physician
assistant, or nurse practitioner. For example, enter 01:45 for 1:45 a.m. or 1:45 p.m. and check the
appropriate box (a.m. or p.m. or Military).
(3) ED discharge – Record the month, day, and 2-digit year the patient was discharged from the ED
in figures, for example, 05/17/09 for May 17, 2009. Record the hour and minutes when the patient
was discharged. For example, enter 04:30 for 4:30 a.m. or 4:30 p.m. and check the appropriate box
(a.m. or p.m. or Military). The ED discharge time should accurately reflect the actual time that the
patient left the ED.
It is important that this item be recorded correctly. Pay special attention to the Military, a.m., and
p.m. boxes. Cross-check Arrival Time (item 1a(1)), Time seen by MD/DO/PA/NP (item 1a(2)), and
ED discharge (item 1a(3)). For example, time of ED discharge should be after the time the patient
entered ED.

ITEM 1b.

ZIP CODE

Enter the 5-digit ZIP Code from patient’s mailing address.

ITEM 1c.

DATE OF BIRTH

Record the month, day, and 4-digit year of the patient's birth in figures, for example, 06/26/2007 for
June 26, 2007. In the rare event the date of birth is unknown, the year of birth should be estimated
as closely as possible.

9

ITEM 1d.

PATIENT RESIDENCE
Residence

Definition

1

Private residence

The patient’s current place of residence is a private home (such as an
apartment, single-family home, townhouse, etc.). This includes the
patient staying at the private home of a friend or relative. A P.O. box
should be considered a private residence, unless there is information to the
contrary.

2

Nursing home

The patient’s current place of residence is a nursing home.

3

Homeless

The patient has no home (e.g., lives on the street) or patient’s current
place of residence is a homeless shelter.

4

Other

The patient’s current place of residence is a hotel, college dormitory,
assisted-living center, or an institution other than a nursing home (such as
a prison, mental hospital, group home for the mentally retarded or
physically disabled, etc.).

5

Unknown

If you cannot determine the patient’s current residence, mark “Unknown.”

ITEM 1e.

SEX

Please check the appropriate category based on observation or your knowledge of the patient or from
information in the medical record.

ITEM 1f.

ETHNICITY

Ethnicity refers to a person's national or cultural group. The ED Patient Record form has two
categories for ethnicity, “Hispanic or Latino” and “Not Hispanic or Latino.”
Mark the appropriate category according to your hospital’s usual practice or based on your
knowledge of the patient or from information in the medical record. You are not expected to ask the
patient for this information. If the patient's ethnicity is not known and is not obvious, mark the box
which in your judgment is most appropriate. The definitions of the categories are listed below. Do
not determine the patient’s ethnicity from their last name.
Ethnicity

Definition

1 Hispanic or Latino

A person of Cuban, Mexican, Puerto Rican, South or Central
American or other Spanish culture or origin, regardless of race.

2 Not Hispanic or
Latino

All other persons.

10

ITEM 1g.

RACE

Mark all appropriate categories based on observation or your knowledge of the patient or from
information in the medical record. You are not expected to ask the patient for this information. If the
patient's race is not known or not obvious, mark the box(es) which in your judgment is (are) most
appropriate. Do not determine the patient’s race from their last name.
Race

Definition

1 White

A person having origins in any of the original peoples of Europe, Middle
East, or North Africa.

2 Black or African
American

A person having origins in any of the black racial groups of Africa.

3 Asian

A person having origins in any of the original peoples of the Far East,
Southeast Asia, or the Indian subcontinent including, for example,
Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam.

4 Native Hawaiian
or Other Pacific
Islander

A person having origins in any of the original peoples of Hawaii, Guam,
Samoa, or other Pacific Islands.

5 American Indian
or Alaska Native

A person having origins in any of the original peoples of North America,
and who maintains cultural identification through tribal affiliation or
community recognition.

ITEM 1h.

ARRIVAL BY AMBULANCE

Ambulance

Definition

1 Yes

The patient arrived in an ambulance, either air or ground. This includes
private and public ambulances that can provide either Advanced Life
Support or Basic Life Support.

2 No

The patient did not arrive by ambulance.

3 Unknown

The mode of arrival is unknown.

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ITEM 1i.

EXPECTED SOURCE(S) OF PAYMENT FOR THIS VISIT

Mark the expected source or sources of payment that will pay for this visit. This information may be
in the patient's file; however, in some hospitals, the billing information may be kept in the business
office.
Mark all sources of payment that apply.
Primary Expected
Source of Payment

Definition

1 Private insurance

Charges paid in-part or in-full by a private insurer (e.g., Blue Cross/Blue
Shield) either directly to the hospital or reimbursed to the patient. Include
charges covered under a private insurance-sponsored prepaid plan.

2 Medicare

Charges paid in-part or in-full by a Medicare plan. Includes payments
directly to the hospital as well as payments reimbursed to the patient.
Include charges covered under a Medicare-sponsored prepaid plan.
Summacare is a health plan servicing the Akron, Ohio area and is
sometimes utilized in lieu of Medicare for that area.

3 Medicaid/SCHIP

Charges paid in-part or in-full by a Medicaid plan. Includes payments
made directly to the hospital as well as payments reimbursed to the
patient. Include charges covered under a Medicaid sponsored prepaid
plan or the State Children’s Health Insurance Program (SCHIP).

4 Worker’s
compensation

Includes programs designed to enable employees injured on the job to
receive financial compensation regardless of fault.

5 Self-pay

Charges, to be paid by the patient or patient’s family, which will not be
reimbursed by a third party. “Self-pay” includes visits for which the
patient is expected to be ultimately responsible for most of the bill, even
though the patient never actually pays it. DO NOT check this box for a
copayment or deductible.

6 No charge/Charity

Visits for which no fee is charged (e.g., charity, special research, or
teaching). Do not include visits paid for as part of a total package (e.g.,
prepaid plan visits, postoperative visits included in a surgical fee, and
pregnancy visits included in a flat fee charged for the entire pregnancy).
Mark the box or boxes that indicate how the services were originally paid.

7 Other

Any other sources of payment not covered by the above categories, such
as CHAMPUS, state and local governments, private charitable
organizations, and other liability insurance (e.g., automobile collision
policy coverage).

8 Unknown

The primary source of payment is not known.

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2.

TRIAGE

ITEM 2a.

INITIAL VITAL SIGNS

Record the following initial vital signs as assessed in triage:
(1) Temperature (check the appropriate box - degrees C or F).
(2) Heart rate – beats per minute.
(3) Respiratory rate – breaths per minute.
(4) Blood pressure – systolic and diastolic.
(5) Pulse oximetry (percent of oxyhemoglobin saturation; value is usually 80-100%).
(6) On oxygen (at time of arrival and/or before pulse oximetry was performed)
(7) Glasgow Coma Scale (range is 3-15; 3-8 indicates that patient is in a coma; 15 is normal).

ITEM 2b.

TRIAGE LEVEL

Enter the triage level assigned by the triage nurse upon ED arrival. Most ED patients will be
assigned a number from 1-5 with the lowest number indicating the most urgent cases. The triage
level may be expressed as a Roman numeral.
Mark “No triage,” if the emergency service area does not perform triage or the patient arrived DOA.
Mark “Unknown,”if the triage level is unknown.

ITEM 2c.

PAIN SCALE

Enter a number from 0 (no pain)-10 (worst pain imaginable) that indicates the level of the patient’s
pain at triage as recorded in the medical record. Mark “Unknown,” if pain level is unknown.
The pain scale for children may consist of 6 faces (0=no hurt to 5=hurts worst). If this is used by the
ED, then adapt it to the 11-point scale by multiplying the value on the faces scale by 2 (e.g., for 5 on
the faces scale, enter 10). For 0 on the faces scale, enter 0.

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3.

PREVIOUS CARE

ITEM 3a.

HAS PATIENT BEEN –
(1) SEEN IN THIS ED WITHIN THE LAST 72 HOURS?

Indicate whether the patient has been seen in this emergency department within the 72 hours prior to
the current visit using the check boxes provided. If you are unable to determine whether the patient
has been seen in this time period, please mark “Unknown.”

(2) DISCHARGED FROM ANY HOSPITAL WITHIN THE LAST 7 DAYS?
Indicate whether the patient has been discharged from any hospital within the last 7 days prior to the
current visit by using the check boxes provided. If you are unable to determine whether the patient
was discharged from any hospital within the last 7 days, mark “Unknown.”

ITEM 3b.

HOW MANY TIMES HAS PATIENT BEEN SEEN IN THIS ED WITHIN THE
LAST 12 MONTHS?

Record how many times the patient has been seen in this ED within the last 12 months. Do not
include the current visit in your total. If you cannot determine how many past visits were made,
mark “Unknown.”

4.

REASON FOR VISIT

ITEM 4a.

PATIENT’S COMPLAINT(S), SYMPTOM(S), OR OTHER REASON(S) FOR
THIS VISIT (use patient’s own words.)

Enter the Patient's complaint(s), symptom(s), or other reason(s) for this visit in the Patient's own
words. Space has been allotted for the “most important” and two “other” complaints, symptoms, and
reasons as indicated below.
(1) Most important
(2) Other
(3) Other

14

The Most Important reason should be entered in (1). Space is available for two other reasons in (2)
and (3). By “most important” we mean the problem or symptom which, in the physician's judgment,
was most responsible for the patient making this visit. Since we are interested only in the patient's
most important complaints/ symptoms/ reasons, it is not necessary to record more than three.
This is one of the most important items on the Patient Record form. No similar data on emergency
department visits are available in any other survey and there is tremendous interest in the findings.
Please take the time to be sure you understand what is wanted--especially the following two points:
♦

We want the patient's principal complaint(s), symptom(s) or other reason(s) in the patient’s own
words. The physician may recognize right away, or may find out after the examination, that the
real problem is something entirely different. In item 4a we are interested in how the patient
defines the reason for the visit (e.g., “cramps after eating,” “fell and twisted my ankle”).

♦

The item refers to the patient’s complaint(s), symptom(s), or other reason(s) for this visit.
Conceivably, the patient may be undergoing a course of treatment for a serious illness, but if
his/her principal reason for this visit is a cut finger or a twisted ankle, then that is the
information we want.

There will be visits by patients for reasons other than some complaint or symptom. Examples might
be follow-up for suture removal or recheck of a heart condition. In such cases, simply record the
reason for the visit.
Reminder: If the reason for a patient's visit is to pay a bill, ask the physician to complete an
insurance form, or drop off a specimen, then the patient is not eligible for the sample. A Patient
Record form should not be completed for this patient.
ITEM 4b.

EPISODE OF CARE

The “Episode of care” attempts to measure the nature of the care provided at the visit, an initial visit
versus a follow-up visit. An episode of care begins with the initial visit for care for a particular
problem and ends when the patient is no longer continuing treatment. A problem may recur later,
but that is considered a new episode of care. An initial visit may be diagnostic in nature whereas a
follow-up visit may be to check progress or continue therapy.
Episode of care

Definition

1

Initial visit for
problem

This is the FIRST VISIT by this patient for care of this particular
problem or complaint.

2

Follow-up visit for
problem

Care was previously provided for this problem. This is the second or
subsequent visit for this problem or complaint.

3

Unknown

Cannot determine if this is the first or follow-up visit for this problem.

Visits for follow-up care for injuries such as removal of casts would be reported under “Follow-up
visit.” An initial visit for a new episode of a chronic problem flare-up would be listed under “Initial

15

visit” whereas a follow-up visit for a chronic problem flare-up would be listed under “Follow-up
visit.”
5.

INJURY/POISONING/ADVERSE EFFECT

ITEM 5a.

IS THIS VISIT RELATED TO AN INJURY, POISONING, OR ADVERSE
EFFECT OF MEDICAL TREATMENT?

Mark the “Yes” or “No” box to indicate whether the patient's visit was due to any type of injury,
poisoning, or adverse effect of medical treatment. The injury/poisoning/adverse effect does not need
to be recent. It can include those visits for follow up of previously treated injuries and visits for
flare-ups of problems due to old injuries. This not only includes injuries or poisonings, but also
adverse effects of medical treatment or surgical procedures (e.g., unintentional cut during a surgical
procedure, foreign object left in body during procedure, and adverse drug events). Include any
prescription, over-the-counter medication or illegal drugs involved in an adverse drug event (e.g.,
allergies, overdose, medication error, drug interactions). If the box is marked “No,” skip to item 6.

ITEM 5b.

IS THIS INJURY/POISONING INTENTIONAL?

Indicate whether the injury was intentional (i.e., self inflicted or an assault), unintentional, or
unknown.

ITEM 5c.

CAUSE OF INJURY, POISONING OR ADVERSE EFFECT

Provide a brief description of the who, what, when, where, and why associated with the injury,
poisoning or the adverse effects of medical treatment or surgical procedures including adverse drug
events (e.g., allergy to penicillin). Refer to page 2 in the NHAMCS-250, which is a Job Aid
designed to assist you with Item 5 of the Patient Record form. Indicate the place of the injury (e.g.,
residence, recreation or sports area, street or highway, school, hospital, public building, or industrial
place). Include any post-surgical complications and if it involved an implant, specify what kind. If
safety precautions were taken, describe them (e.g., seat belt use). Be sure to include the mechanism
that caused the injury (e.g., farm equipment, fire, arsenic, knife, pellet gun). If it was a work-related
injury or poisoning, specify the industry of the patient’s employment (e.g., food service, agricultural,
mining, health services, etc.).
Describe in detail the circumstances that caused the injury (e.g., fell off monkey bars, motor vehicle
collision with another car, spouse beaten with fists by spouse). Include information on the role of
the patient associated with the injury (e.g., bicyclist, pedestrian, unrestrained driver or passenger in a
motor vehicle, horseback rider), the specific place of occurrence (e.g., lake, school football field),
and the activity in which the patient was engaged at the time of the injury (e.g., swimming, boating,
playing football).

16

Also include what happened to the patient and identify the mechanism of injury that was
immediately responsible for the injury. In addition, record the underlying or precipitating cause of
injury (i.e., the event, or external cause of injury that initiated and led to the mechanism of injury).
An example is a house fire that caused a person to jump out of the window. Both the precipitating
or underlying cause (house fire) and the mechanism (fall from roof) would be important to record. It
is especially important to record as much detail about falls and motor vehicle crashes as possible. For
fall, indicate what the fall was from (e.g., steps) and where the patient landed (e.g., pavement). For
motor vehicle crash, indicate if it occurred on the street or highway versus a driveway or parking lot.
The National Center for Health Statistics will use the information collected to classify the cause of
the injury using the International Classification of Diseases, Supplementary Classification of
External Causes of Injury and Poisoning codes (ICD-9-CM E-Codes).

6.

PROVIDER’S DIAGNOSIS FOR THIS VISIT

ITEM 6a.

As specifically as possible, list diagnoses related to this visit including chronic
conditions.

This is one of the most important items on the Patient Record form. Item 6(1) refers to the
physician’s primary diagnosis for this visit. While the diagnosis may be tentative, provisional, or
definitive it should represent the physician's best judgment at this time, expressed in acceptable
medical terminology including “problem” terms. If the patient was not seen by a physician, then the
diagnosis by the main medical provider should be recorded. If a patient appears for postoperative
care (follow up visit after surgery), record the postoperative diagnosis as well as any other. The
postoperative diagnosis should be indicated with the letters “P.O.”
(1) Primary diagnosis
(2) Other
(3) Other
Space has been allotted for two “other” diagnoses. In items 6(2) and 6(3) list the diagnosis of other
conditions related to this visit. Include chronic conditions (e.g., hypertension, depression, etc.) if
related to this visit.

ITEM 6b.

Does the patient have –

Mark all that apply.
Condition

Definition

1

Cerebrovascular
disease/History of stroke

Includes stroke, transient ischemic attacks (TIAs), and history of
stroke.

2

Congestive heart failure

Congestive heart failure or cardiomyopathy. Does not include
asystole or cardiac arrest.
17

7.

3

Condition requiring
dialysis

Includes end-stage renal disease (ESRD) and chronic kidney failure
due to diabetes or hypertension that requires the patient to be on
kidney dialysis. Include both hemodialysis and peritoneal dialysis.

4

HIV

Human immunodeficiency virus and AIDS.

5

Diabetes

Includes both insulin dependent diabetes mellitus (IDDM) and
noninsulin dependent diabetes mellitus (NIDDM). DoesNOT
include diabetes insipidus.

6

None of the above

Mark (X) if none of the conditions above exist.

DIAGNOSTIC/SCREENING SERVICES

Mark all services that were ordered or provided during this visit for the purpose of screening (i.e.,
early detection of health problems in asymptomatic individuals) or diagnosis (i.e., identification of
health problems causing individuals to be symptomatic). EACH SERVICE ORDERED OR
PROVIDED SHOULD BE MARKED.
Mark the “NONE” box if no blood tests, imaging services, or other tests were ordered or provided.
If services were ordered or provided but not listed, mark the “Other blood test,” “Other test/service,”
or “Other imaging” boxes.
Services meriting special attention are as follows:
Answer
Box
Service

Special Instruction

Blood tests
2

CBC

CBC is a complete blood count and includes white blood cell (WBC) count,
hemoglobin, hematocrit, platelets, and other indices.

3

BUN/Creatinine

BUN is blood urea nitrogen. BUN and creatinine are kidney tests.

4

Cardiac enzymes

May be abbreviated as CE.Include any of the following tests: CKMB (MB
fraction of creatine kinase) or CPK-MB; troponin I or troponin T (Tnl, cTnl).

5

Electrolytes

Include any of the following 4 tests: sodium (Na), chloride (Cl), potassium
(K), bicarbonate (HCO3) or carbon dioxide (CO2).

7

Liver function
tests

May be abbreviated as LFT. Include any of the following tests: SGPT
(serum glutamate pyruvate transaminase) or ALT (alanine transaminase),
SGOT (serum glutamic-oxaloacetic transaminase) or AST (aspartate
aminostransferase), GGT (gamma-glutamyl transpeptidase), and serum
bilirubin.
18

Answer
Box
Service

Special Instruction

8

Arterial blood
gases

May be abbreviated as ABG. An artery is punctured, usually in the wrist
(radial artery), and measures the levels of pH, oxygen (PO2 or PaO 2) carbon
dioxide (PCO2 or PaCO2), bicarbonate (HCO3), and oxygen saturation
(SaO2). ABG is not the same as a venous blood gas (VBG).

9

Prothrombin time PT/INR. INR is International Normalized Ratio. Usually collected with
/INR
PTT (partial thromboplastin time). May be called “coags.”

10

Blood culture

May be abbreviated as BC. Cx = culture. Determines if bacteria or fungi
are present in the blood. Often obtained in sets of 2 or 3 at the same time.

Other tests
16

Influenza test

Includes any type of influenza test, i.e., nasal or throat swab (rapid), nasal
culture, or serology (blood).

18

Toxicology
screen

Tests for several drugs of abuse and is usually a urine sample, but could
also be blood.

20

Wound culture

Used to detect and identify bacteria or fungi that may be infecting the skin
or wound. Specimen is usually obtained by a cotton swab of pus or the
wound base.

Basic blood chemistry panels (e.g., SMA7, Chem-1, CPBASIC, BMP) include kidney tests (BUN
and creatinine), electrolytes (sodium, potassium, bicarbonate, and chloride), and glucose.
Comprehensive blood chemistry panels (e.g., SMA18, Chem-2, CPCOMP, CMP) include the 7 tests
in the basic panel as well as others (e.g., bilirubin, alkaline phosphatase, etc.)

8.

PROCEDURES

Mark all procedures provided at this visit. Mark the “NONE” box if no procedures were provided.
Procedure

Definition

1

None

No procedures provided.

2

IV fluids

Administration of intravenous fluids.

3

Cast

Application of a rigid dressing made of plaster or fiberglass, molded to
the body while pliable and hardening as it dries, to give firm support.

4

Splint or wrap

Application of a rigid or flexible appliance used to maintain in position a
displaced or moveable part, or to keep in place and protect an injured
19

part. May also be made of plaster, but is not circumferential.

9.

5

Suturing/Staples

Process of using stitches, sutures, or staples to hold skin or tissue
together.

6

Incision &
drainage (I&D)

Incision and drainage (I&D) is a common treatment for skin infections
and abscesses. A scalpel is inserted into the skin overlying the pus and
the pus is drained.

7

Foreign body
removal

Process of removing an object found in a part of the body where it does
not naturally occur.

8

Nebulizer
therapy

Therapy where bronchodilator (airway-opening) medications (e.g.,
albuterol, ipratropium) are delivered through a nebulizer which changes
liquid medicine into fine droplets (in aerosol or mist form) that are
inhaled through a mouthpiece or facemask. Used for patients with
asthma or COPD (chronic obstructive pulmonary disease).

9

Bladder catheter

Any type of catheter used to obtain urine from the bladder (e.g., Foley).

10

Pelvic exam

An examination of the organs of the female reproductive system.

11

Central line

A central venous line (also known as central venous catheter or CVC) is
usually inserted into a large vein in the neck, chest, or groin to administer
medications or fluids and to obtain blood for testing and cardiovascular
measurements.

12

CPR

Cardiopulmonary resuscitation.

13

Endotracheal
intubation

Insertion of a laryngoscope into the mouth followed by a tube into the
trachea. May sometimes be inserted through the nose.

14

Other

Mark if other procedures were provided but not listed.

MEDICATIONS & IMMUNIZATIONS

List up to 8 drugs given at this visit or prescribed at ED discharge, using either the brand or generic
names. Include prescription and over-the-counter drugs, immunizations, and anesthetics.
Record the exact drug name (brand or generic) written on any prescription or medical record.
Do not enter broad drug classes, such as “laxative,” “cough preparation,” “analgesic,” “antacids,”
“birth control pill,” or “antibiotics.” The one exception is “allergy shot.”
Limit entries to drug name only. Additional information such as dosage, strength, or regimen is
not required. For example, the medication might be in the forms of pills, injections, salves or
20

ointments, drops, suppositories, powders, or skin patches, but this information should not be entered
on the Patient Record form.
For each drug listed, mark the appropriate box indicating if the medication was given in the ED or
prescribed at discharge. If the same drug was both given in the ED and prescribed at discharge, then
mark (X) both boxes.
If more than eight drugs were given in the ED and/or prescribed at ED discharge, then record the
medications/immunizations according to the following priority:
1. All medications (including OTC drugs)/immunizations associated with the listed diagnoses
2. All medications (including OTC drugs)/immunizations given in the ED, excluding vitamins and
dietary supplements
3. All medications (including OTC drugs)/immunizations prescribed at discharge, excluding
vitamins and dietary supplements
4. Vitamins and dietary supplements

10. PROVIDERS

Mark all providers seen during this visit. If care was provided, at least in part, by a person not
represented in the seven categories, mark the “Other” box.
Answer
Box

Provider

Provider (Definition)

3

Consulting
physician

Physician who is called to the ED by the patient’s ED provider and
who may leave a consultation note.

7

EMT

EMT is emergency medical technician. Only mark this box if an
EMT provided care in the ED as opposed to in the ambulance.

8

Mental health
provider

Include psychologists, counselors, social workers, and therapists
who provide mental health counseling. Exclude psychiatrists.

11. SERVICE LEVEL

Mark the level of emergency service. CPT (Current Procedural Terminology) codes are used by the
ED physician for billing purposes.
Answer
Box

Level

CPT Code (Definition)

21

1

1 (99281)

An ED visit for a self-limited or minor problem that includes a
problem focused history, problem focused examination, and
straightforward medical decision making.

2

2 (99282)

An ED visit for a problem of low to moderate severity that includes
an expanded problem focused history, expanded problem focused
examination, and medical decision making of low complexity.)

3

3 (99283)

An ED visit for a problem of moderate severity that includes an
expanded problem focused history, expanded problem focused
examination, and medical decision making of moderate complexity.

4

4 (99284)

An ED visit for a problem of moderate to high severity that includes
a detailed history, detailed examination, and medical decision
making of moderate complexity.

5

5 (99285)

An ED visit for a problem of high severity that includes a
comprehensive history, comprehensive examination, and medical
decision making of high complexity.

6

Critical care
(99291)

Evaluation and management of a critically ill or injured patient.

7

Unknown

CPT Code is not indicated.

12. VISIT DISPOSITION
Mark all that apply.
Visit Disposition

Definition

1

No follow-up
planned

No return visit or telephone contact is scheduled or planned for the
patient’s problem.

2

Return if needed,
PRN/appointment

The patient is instructed to return to the ED as needed; or the patient
was told to schedule an appointment or was given an appointment to
return to the ED at a particular time.

3

Return/Refer to
physician/clinic for
FU

The patient was referred to the ED by his or her personal physician or
some other physician and is now instructed to consult with the
physician who made the referral. The patient was screened,
evaluated, stabilized, and then referred to another physician or clinic
for followup.

4

Left before medical
screening exam

The patient left before having a medical screening exam, the purpose
of which is to determine if an emergency medical condition exists.

5

Left after medical

The patient left after having a medical screening exam, the purpose of
22

screening exam

which is to determine if an emergency medical condition exists.

6

Left AMA

The patient left against medical advice, that is, the patient was
evaluated by the hospital staff and advised to stay and receive or
complete treatment.

7

DOA

The patient was dead on arrival (DOA). This patient is still included
in the sample if listed on the arrival log.

8

Died in ED

The patient died in the ED. This patient is still included in the sample
if listed on the arrival log.

9

Transfer to
psychiatric hospital

The patient was transferred to a psychiatric hospital.

10

Transfer to other
hospital

The patient was transferred to another non-psychiatric hospital.

11

Admit to this
hospital

The patient was instructed that further care or treatment was needed
and was admitted to this hospital. If “Admit to hospital” was marked,
then continue with item 13 – HOSPITAL ADMISSION on the
reverse side.

12

Admit to
observation unit,
then hospitalized

The patient was admitted to a designated observation unit operated by
the ED for evaluation and management or to wait for an inpatient bed,
and then was admitted to the hospital. If “Admit to observation unit,
then hospitalized” was marked, then continue with item 13 –
HOSPITAL ADMISSION on the reverse side.

13

Admit to
observation unit,
then discharged

The patient was admitted to a designated observation unit in the ED
for evaluation and management, but was discharged from the ED and
was never admitted to a hospital. If “Admit to observation unit, then
discharged” was marked, then continue with item 14 –
OBSERVATION UNIT STAY on the reverse side.

14

Other

Any other disposition not included in the above list.

13. HOSPITAL ADMISSION

If box either “12 – Admit to observation unit, then hospitalized” or “13 – Admit to hospital” in
ITEM 12. VISIT DISPOSITION was marked, continue on the reverse side of the NHAMCS100(ED) and complete ITEM 13. HOSPITAL ADMISSION. If the information for items 13e-13g
are not available at the time of the abstraction, then complete the NHAMCS-105, Hospital
Admission Log. If efforts have been exhausted to collect the data, mark the “Unknown” box for
each item.

23

If box “11 – Admit to observation unit, then discharged” in ITEM 12. VISIT DISPOSITION
was marked, continue on the reverse side of the NHAMCS-100(ED) and complete ITEM 14.
OBSERVATION UNIT STAY.

24

ITEM 13a.

ADMITTED TO:
Type of Unit

ITEM 13b.

Definition

1 Critical care unit

The patient was admitted to a critical care unit of the hospital (e.g.,
Intensive Care Unit (ICU), Coronary Care Unit (CCU), Pediatric
Intensive Care Unit (PICU)).

2 Stepdown or
telemetry unit

The patient was admitted to a stepdown or telemetry unit area of
the hospital where special machines are used to closely monitor
patients. The level of care is less intense than in the ICU, but is
not present in all hospitals.

3 Operating room

The patient was sent directly to the operating room.

4 Mental health
or detox unit

The patient was admitted to a mental health or psychiatric unit or
a unit providing detoxification services for drugs and alcohol.

5 Cardiac
catheterization lab

The patient was sent directly to the cardiac catheterization lab.

6 Other bed/unit

The patient was admitted to a bed/unit in the hospital not listed
above (e.g., med/surg unit).

7 Unknown

Information is not available to determine where the patient was
admitted.

ADMITTING PHYSICIAN

Indicate whether the admitting physician is a hospitalist. A hospitalist is a physician whose primary
professional focus is the general medical care of hospitalized patients. A hospitalist oversees ED
patients being admitted to the hospital. If the records do not indicate that the admitting physician is
a hospitalist, mark “Unknown.”

ITEM 13c.

DATE AND TIME BED WAS REQUESTED FOR HOSPITAL ADMISSION

Record the month, day, and year in figures when a bed was requested for hospital admission, for
example 05/17/09 for May 17, 2009. Record the hour and minutes when the bed request was made
in figures. For example, enter 05:45 and check the appropriate box (a.m., p.m., or Military).
If the date and time when a bed was requested is unknown, mark the appropriate box.

ITEM 13d.

DATE AND TIME PATIENT ACTUALLY LEFT ED

Record the month, day, and year in figures when the patient actually left the ED, for example
05/17/09 for May 17, 2009.
25

Record the hour and minutes when the patient actually left the ED in figures. For example, enter
06:00 for 6:00 a.m. or 6:00 p.m. and check the appropriate box (a.m., p.m., or Military).
If the date and time when the patient actually left the ED is unknown, mark the appropriate box.

ITEM 13e.

HOSPITAL DISCHARGE DATE

Record the month, day, and year in figures when the patient was discharged from an inpatient stay in
the hospital, for example, 05/17/09 for May 17, 2009. If the date and time when the patient was
discharged from the hospital is unknown, mark the appropriate box.

ITEM 13f.

PRINCIPAL HOSPITAL DISCHARGE DIAGNOSIS

Enter the principal hospital discharge diagnosis. If the discharge diagnosis is unknown, mark the
appropriate box.

ITEM 13g.

HOSPITAL DISCHARGE STATUS/DISPOSITION

Mark the appropriate box to indicate whether the patient was discharged alive, dead, the discharge
status is unknown, or the data are unavailable. If the patient was discharged “Alive,” mark one of
the following:
Status

Definition

1

Home/Residence

The patient was discharged to their normal place of residence (e.g., private
home, assisted living, nursing home, college dormitory, homeless shelter,
hospice, prison, or group home for mentally retarded or physically
disabled).

2

Transferred

The medical record states that the patient was transferred to another
facility that is not their normal place of residence (e.g., psychiatric
hospital, detox, rehabilitation hospital, another short-term hospital,
nursing home, skilled nursing facility (SNF), intermediate care facility
(ICF), extended care facility, custodial).

3

Other

Any other disposition where the patient neither returned to their normal
place of residence nor were transferred.

4

Unknown

Information is not available to determine where the patient was
discharged to.

26

14. OBSERVATION UNIT STAY

ITEM 14.

OBSERVATION UNIT STAY

COMPLETE THIS ITEM FOR PATIENTS WHO WERE DISCHARGED FROM THE
OBSERVATION UNIT TO RETURN TO THEIR RESIDENCE.
Record the month, day, and year in figures when the patient was discharged from the observation
unit, for example 05/17/09 for May 17, 2009.
Record the hour and minutes when the patient was discharged from the observation unit. For
example, enter 05:45 for 5:45 a.m. or 5:45 p.m. and check the appropriate box (a.m., p.m., or
Military).
If the date and time when the patient was discharged from the observation unit is unknown, mark the
appropriate box.

27

*All names and examples referenced in this instruction booklet are fictional and in no way represent actual
situations or individuals

28

EXHIBIT A
ENDORSEMENT LETTER FROM ACEP

Ε−1

Ε−2

EXHIBIT B
ENDORSEMENT LETTER FROM SAEM

Ε−3

Ε−4

EXHIBIT C
ENDORSEMENT LETTER FROM ENA

Ε−5

EXHIBIT D
ENDORSEMENT LETTER FROM ACOEP

Ε−6

EXHIBIT E
ENDORSEMENT LETTER FROM THE SURGEON GENERAL’S OFFICE

Ε−7

EXHIBIT F
ENDORSEMENT LETTER FROM THE FEDERATION OF AMERICAN HOSPITALS

Ε−8

EXHIBIT G

Illustrative Uses of NHAMCS ED Data
Health Care Facilities
Kaiser Permanente

Studied the utilization of physician assistants and nurse
practitioners in EDs.

Massachusetts General Hospital

Published article in Academic Emergency Medicine on
declining antibiotic prescriptions for patients with upper
respiratory infections seen in the ED.

Universities and Medical Schools
George Washington University Medical
Center

Published article in Annals of Emergency Medicine on
increasing rates of ED visits for elderly patients.

Harvard Medical School

Published article in Health Affairs on trends and predictors of
the waiting time to see an ED physician.

University of California,
San Francisco

Published article in the Journal of the American Medical
Association on trends in opioid prescribing in the ED by race
and ethnicity.

Government Agencies
U.S. Congress

NHAMCS data are used in two annual reports to Congress –
The National Healthcare Quality Report and the National
Health Disparities Report.

Institute of Medicine

Future of Emergency Care report cited ED data over 100 times.

Assistant Secretary for Planning and
Evaluation,
Department of Health and Human Services

Requested that a supplement be added to the NHAMCS to
assess how well hospitals are prepared to provide services in
the event of a pandemic, mass casualty, or terrorist attack.

Government Accountability Office

Requested ED trend data to examine ED crowding and to
evaluate the Emergency Medical Treatment and Labor Act
(EMTALA).

Broadcast and Print Media
NBC Nightly News, August 6, 2008

Reported on the increase in ED visits from 1996 through 2006.

Wall Street Journal, August 7, 2008

Reported on average ER waiting time jumping to nearly an
hour.

Advocacy Groups
Center for Studying Health System Change

Used ED data in its issue brief “Insured Americans Drive
Surge in Emergency Department Visits.”

Council on the Economic Impact of Health
System Change

Used ED data in its report on “Utilization and Overcrowding in
Hospital Emergency Departments.”

Ε−9

EXHIBIT H
OPTIONAL PATIENT LOG FORM (EXAMPLE)

Ε − 10

Ε − 11

EXHIBIT I
ED PATIENT RECORD FORM

Ε − 12

Ε − 13

EXHIBIT J
NHAMCS PARTICIPANT WEB PAGE

Ε − 14