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The numerator thresholds were developed according to evidence and consensus-based clinical guidelines for ED time thresholds, including guidelines developed by The Joint Commission (TJC), the American College of Emergency Physicians (ACEP), and the Emergency Department Benchmarking Alliance as well as input from a TEP, literature reviews, and environmental scans

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We recognize that bed and provider shortages or limited post-acute options can affect ED times but reiterate that the measure is meant to highlight and provide insight to general patterns in access and timeliness