This database was last updated in September 2019. It should only be used as
a historical snapshot.Researchers can find more recent data on timely and
effective care in the Centers for Medicare and Medicaid Services’
hospitals datasets
and
guidance about hospital regulations.
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About this Data
CMS Timely and Effective Care
Much of the data in this interactive database comes from the Centers for Medicare and Medicaid Services' Timely and Effective Care datasets at the hospital, state and national levels. Long wait times are often signals of overcrowding or staff shortages. Here are the measures we include and CMS' definitions for them:
OP_18b
Average (median) time patients spent in the emergency department before leaving from the visit.
OP_22
Percentage of patients who left the emergency department before being seen.
ED_1b
Average (median) time patients spent in the emergency department, before they were admitted to the hospital as an inpatient
ED_2b
Average (median) time patients spent in the emergency department, after the doctor decided to admit them as an inpatient before leaving the emergency department for their inpatient room.
OP_23
Percentage of patients who came to the emergency department with stroke symptoms who received brain scan results within 45 minutes of arrival.
CMS Hospital Inspection Violations
We also use data from CMS' hospital inspection reports. CMS only releases violations cited by government inspectors during reviews prompted by complaints. It does not include violations cited by private accrediting organizations or those found during routine hospital inspections by regulators.
While CMS releases data on all types of hospital violations, we pull out only the violations related to ER care. These include violations relating to not properly assessing and treating patients, inadequate medical and nursing staff and not following ER policies and procedures. It also includes violations of the Emergency Medical Treatment and Active Labor Act (EMTALA), which requires ERs to provide a medical screening examination and treatment to stabilize anyone who comes to the emergency department, regardless of their ability to pay.
Once an inspection is complete, hospitals are given 10 calendar days to respond or dispute a violation. If CMS agrees with the dispute, it may revise the inspection report. CMS updates this dataset quarterly.
Here are the specific types of violations we include in ER Inspector and CMS' definitions for them:
A1100
The hospital must meet the emergency needs of patients in accordance with acceptable standards of practice.
A1101
If emergency services are provided at the hospital, the hospital must ensure that specific emergency services organization and direction requirements are met.
A1102
If emergency services are provided at the hospital, the services must be organized under the direction of a qualified member of the medical staff.
A1103
If emergency services are provided at the hospital, the services must be integrated with other departments of the hospital.
A1104
If emergency services are provided at the hospital, the policies and procedures governing medical care provided in the emergency service or department are established by and are a continuing responsibility of the medical staff.
A1110
The hospital must ensure the emergency services personnel requirements are met.
A1111
The emergency services must be supervised by a qualified member of the medical staff.
A1112
There must be adequate medical and nursing personnel qualified in emergency care to meet the written emergency procedures and needs anticipated by the facility.
EMTALA related violations:
A2400/C2400
Policies and Procedures Which Address Anti-Dumping Provisions
A2401/C2401
Receiving Hospitals Must Report Suspected Incidences of Individuals With An Emergency Medical Condition Transferred in Violation of §489.24(e)
A2402/C2402
Sign Posting
A2403/C2403
Maintain Transfer Records for Five Years
A2404/C2404
On-Call Physicians
A2405/C2405
Logs
A2406/C2406
Appropriate Medical Screening Examination
A2407/C2407
Stabilizing Treatment
A2408/C2408
No Delay in Examination or Treatment in Order to Inquire About Payment Status
A2409/C2409
Appropriate Transfer
A2410/C2410
Whistleblower Protections
A2411/C2411
Recipient Hospital Responsibilities (Nondiscrimination)
CMS Patient Satisfaction
Finally, we also use data from CMS' patient satisfaction survey. This is a national, standardized survey of hospital patients about their experiences during a recent inpatient hospital stay. Here's the measure we include in ER Inspector and CMS' definition of it:
H_RECMND_DY
Patients who reported YES, they would definitely recommend the hospital
Notes
“Average time” refers to the median wait time (the midpoint of all patients' wait times). References to “doctor or medical practitioner” indicate a doctor, nurse practitioner or physician's assistant. CMS reports the CT scan quality measure as the percentage of patients who received a scan within 45 minutes. We have reversed that measure so that all measures follow a “lower is better” pattern.
Additional design and development by Mike Tigas and Sisi Wei.
Sources
All data comes from the Centers for Medicare and Medicaid Services. Detailed quality measures at the hospital, state and national level were last updated September 2019. Most data was collected between October 2017 and October 2018. Data on ER-related violations is from January 2015 to June 2019.
Additional Info
How We've Updated ER Inspector | Download ProPublica's Emergency Room Planning Toolkit | About This Data
Don’t See Your ER?
In some cases we aren’t able to identify the exact location of a hospital, so it doesn’t appear on our mapped search results. However, it may still be in our database – try looking for it in the list of hospitals on each state's page.
In other cases, the hospital is missing from our database because it doesn't have an emergency department.
In other cases, the hospital is missing from the federal government’s Centers for Medicare and Medicaid Services (CMS) data. There are a couple of reasons why a hospital isn’t included in CMS data: it may not participate in Medicare, or it may share a certification number with another hospital (common across large hospital systems).
If you notice a hospital missing from our database, please first check if you can find it on CMS' website, and that it is listed as having an ER. If so, please email us with the hospital name and address.