[Federal Register Volume 74, Number 10 (Thursday, January 15, 2009)]
[Notices]
[Pages 2596-2598]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-537]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.

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SUMMARY: This notice announces the intention of the Agency for 
Healthcare Research and Quality (AHRQ) to request that the Office of 
Management and Budget (OMB) approve the proposed information collection 
project: ``Improving Patient Flow and Reducing Emergency Department 
Crowding.'' In accordance with the Paperwork Reduction Act of 1995, 44 
U.S.C. 3506(c)(2)(A), AHRQ invites the public to comment on this 
proposed information collection.

DATES: Comments on this notice must be received by March 16, 2009.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by e-mail at 
[email protected]. Copies of the proposed collection plans, 
data collection instruments, and specific details on the estimated 
burden can be obtained from the AHRQ Reports Clearance Officer.

FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports 
Clearance Officer, (301) 427-1477, or by e-mail at 
[email protected].

SUPPLEMENTARY INFORMATION:

Proposed Project

``Improving Patient Flow and Reducing Emergency Department Crowding''

    AHRQ proposes to study implementation of strategies from the Urgent 
Matters (UM) Toolkit for improving patient flow in emergency 
departments (ED). UM, a Robert Wood Johnson Foundation (RWJF) funded 
initiative, began as a collaborative of 10 urban, safety net hospitals 
that experimented with a variety of strategies (now included in the 
``UM Toolkit'') designed to relieve ED crowding. The first phase of 
this initiative demonstrated that reductions in ED crowding were 
achievable without investment of significant financial resources. 
However, implementation of these strategies has not been widespread, 
and questions remain about how readily the strategies could be 
implemented in a more diverse group of hospitals, and the associated 
costs and outcomes of implementation. This study is funded by a grant 
from RWJF to AHRQ.
    Six diverse hospitals have been selected for this study of the 
implementation of strategies from the UM Toolkit for improving ED 
patient flow. This study poses a common outcome goal across all six 
sites of improving patient flow and reducing ED crowding, but requires 
each hospital to select strategies that fit its own needs amid context. 
This approach rests on innovation research showing that organizational 
innovations are more successful when they are aligned with features of 
the adopting hospital. Participating hospitals will select strategies 
from the UM Toolkit that they believe will work best to address the 
particular problems they face. The six hospitals have agreed to 
participate in a collaborative run by the UM National Program Office 
(NPO) over the course of this study to facilitate the sharing of data 
and experiences while the project is under way.
    This study will document the experiences of a diverse set of 
hospital EDs as they identify and implement ED patient flow improvement 
strategies. The six case study hospitals were selected to reflect 
diversity of size, ownership, teaching status, safety net status, and 
types of challenges with ED crowding.
    Research methods will include observational site visits, in-person 
and telephone interviews, and the analysis of cost data. AHRQ's 
contractor for this study, Health Research & Educational Trust (HRET), 
will perform analysis of secondary data on ED performance measures; 
this secondary data will be provided to HRET by the Urgent Matters NPO. 
These qualitative and quantitative methods will be used to:
     Study the processes through which hospitals decide upon 
and adopt patient flow improvement strategies;
     Identify facilitators and barriers to the implementation 
and maintenance of these strategies;
     Document changes in patient flow, patient satisfaction, 
and staff satisfaction associated with the implementation of strategies 
and processes;
     Generate estimates of the costs of adopting the 
strategies;
     Identify issues associated with the reporting of ED 
performance measures, and
     Develop lessons for hospitals considering the adoption of 
patient flow improvement strategies.
    The study will not be used to answer questions about causality or 
degrees of effectiveness (e.g to what degree did a

[[Page 2597]]

given intervention cause an improvement in patient flow?). Rather, the 
study seeks to enhance understanding of factors affecting decision-
making and adoption processes that facilitate or hinder implementation. 
Insights and lessons learned about organizational, technical and 
resource challenges arising from these improvement activities may be of 
interest or benefit to others seeking to identify and adopt strategies 
to address similar problems in their EDs.
    This study is being conducted pursuant to AHRQ's statutory 
authority to conduct and support research on health care and on systems 
for the delivery of such care, including activities with respect to: 
The quality, effectiveness, efficiency, appropriateness and value of 
health care services; quality measurement and improvement; and health 
care costs, productivity, organization, and market forces. 42 U.S.C. 
299a(a)(1), (2), and (6).

Method of Collection

    AHRQ seeks approval for the following data collection activities:
     In-person interviews will be conducted within two months 
of the implementation with up to 12 individuals at each of the 6 sites 
during two-day site visits to each of the hospitals.
     Telephone interviews will be conducted approximately 6 
months after implementation with 12 individuals from each of the six 
hospitals (most or all of whom will be the same individuals interviewed 
in person).
     Each of the six hospitals will submit information on the 
costs associated with the planning, implementation, and maintenance of 
the patient flow improvement strategies on a monthly basis. One study 
team member at each site will record costs on an assessment instrument 
specifically designed for this purpose and tailored to each hospital's 
own organizational structure and patient flow strategies.
    This assessment instrument will collect information on staff time 
devoted to the patient flow improvement initiatives as well as the 
costs of items or resources purchased to support the initiatives.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
hospitalst time to participate in this study. In-person interviews will 
be conducted within two months of implementation with 12 administrative 
and clinical personnel from each of the six participating hospitals and 
will require about one hour. Telephone interviews will be conducted 
approximately six months thereafter with 12 individuals (administrative 
and clinical) from each hospital and will take about 45 minutes. 
Monthly cost assessment data will be collected from each participating 
hospital each month and will require about one hour. The total 
estimated burden for participation in this study is 198 hours.
    Exhibit 2 shows the estimated annualized cost burden for the 
respondents' time to provide the requested data. The total cost burden 
is approximately $6,536.

                                  Exhibit 1--Estimated Annualized Burden Hours
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                                                                     Number of
                 Data collection                     Number of     responses per     Hours per     Total burden
                                                    respondents     respondent       response          hours
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In-person interviews............................               6              12               1              72
Telephone interviews............................               6              12           45/60              54
Cost Assessment.................................               6              12               1              72
                                                 ---------------------------------------------------------------
    Total.......................................              18              na              na             198
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                                   Exhibit 2--Estimated Annualized Cost Burden
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                                                                                      Average
                 Data collection                     Number of     Total burden     hourly wage     Total cost
                                                    respondents        hours           rate*          burden
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In-person interviews............................               6              72          $35.07          $2,525
Telephone interviews............................               6              54           35.07           1,984
Cost Assessment.................................               6              72           28.15           2,027
                                                 ---------------------------------------------------------------
    Total.......................................              18             198              na           6,536
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* For the interviews, the hourly rate of $35.07 is an average of the administrative personnel hourly wage of
  $14.53, the physician rate of $62.52, and the registered nurse rate of $28.15. For cost assessment, the hourly
  rate of $28.15 is the hourly rate for registered nurses. National Compensation Survey: Occupational Wages in
  the United States 2005, U.S. Department of Labor, Bureau of Labor Statistics.

Estimated Annual Costs to the Federal Government

    Exhibit 3 shows the total and annualized cost to the government for 
this eighteen-month study.

                        Exhibit 3--Estimated Cost
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                                                            Annualized
             Cost component                 Total cost         cost
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Project Development.....................         $52,446         $34,964
Data Collection Activities..............          90,298          60,199

[[Page 2598]]

 
Data Processing and Analysis............          70,569          47,046
Publication of Results..................          41,420          27,613
Project Management......................          68,908          45,939
Overhead................................          76,320          50,880
                                         -------------------------------
    Total...............................         399,961         266,641
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Request for Comments

    In accordance with the above-cited Paperwork Reduction Act 
legislation, comments on AHRQ's information collection are requested 
with regard to any of the following: (a) Whether the proposed 
collection of information is necessary for the proper performance of 
AHRQ's health care research and health care information dissemination 
functions, including whether the information will have practical 
utility; (b) the accuracy of AHRQ's estimate of burden (including hours 
and costs) of the proposed collection(s) of information; (c) ways to 
enhance the quality, utility, and clarity of the information to be 
collected; and (d) ways to minimize the burden of the collection of 
information upon the respondents, including the use of automated 
collection techniques or other forms of information technology.
    Comments submitted in response to this notice will be summarized 
and included in the Agency's subsequent request for OMB approval of the 
proposed information collection. All comments will become a matter of 
public record.

    Dated: December 30, 2008.
Carolyn M. Clancy,
Director.
 [FR Doc. E9-537 Filed 1-14-09; 8:45 am]
BILLING CODE 4160-90-M