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The financial burden of emergency department congestion and hospital crowding for chest pain patients awaiting admission.
Ann Emerg Med. 2005 Feb; 45(2):110-7.AE

Abstract

STUDY OBJECTIVE

We determined the additional cost of an extended emergency department (ED) length of stay for chest pain patients awaiting non-ICU, monitored (telemetry) beds.

METHODS

This was a prospective cohort study of all ED chest pain patients aged 24 years or older and admitted to a telemetry bed in an urban university hospital during a 12-month period. Structured ED data collection included demographics, chest pain presentation, medical history, and laboratory test and ECG results. Hospital course was monitored daily, followed by a 30-day telephone follow-up. Risk severity scores (Goldman, Acute Cardiac Ischemia-Time-Insensitive Predictive Instrument, and Charlson) were calculated. Hospital charges, real costs, and revenues were obtained at discharge and 2 years later. The main outcome measure was risk-adjusted additional cost to the hospital of a delayed ED admission. Clinical outcome was a secondary measure.

RESULTS

Of the 817 patients with chest pain presenting to the ED during the study period, there were 904 hospitalizations. Of these, 825 patients waited more than 3 hours for their bed (91%). There were 21 patient visits with a final diagnosis of acute myocardial infarction. ED length of stay was not associated with total hospital length of stay (r =0.01), hospital costs, or hospital or professional charges, revenues, or collection rates. The annual opportunity cost in lost hospital revenue for chest pain patients was 168,300 US dollars (204 US dollars per patient waiting >3 hours for a hospital bed).

CONCLUSION

Extended ED length of stay demonstrated no association with total hospital costs or revenues or total hospital length of stay but imposed substantial ED opportunity costs, with decreased potential revenue. Interventions that reduce ED delays in hospital admissions have the potential to significantly increase hospital revenues.

Authors+Show Affiliations

Department of Medicine, School of Medicine, The Wharton School.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15671965

Citation

Bayley, Matthew D., et al. "The Financial Burden of Emergency Department Congestion and Hospital Crowding for Chest Pain Patients Awaiting Admission." Annals of Emergency Medicine, vol. 45, no. 2, 2005, pp. 110-7.
Bayley MD, Schwartz JS, Shofer FS, et al. The financial burden of emergency department congestion and hospital crowding for chest pain patients awaiting admission. Ann Emerg Med. 2005;45(2):110-7.
Bayley, M. D., Schwartz, J. S., Shofer, F. S., Weiner, M., Sites, F. D., Traber, K. B., & Hollander, J. E. (2005). The financial burden of emergency department congestion and hospital crowding for chest pain patients awaiting admission. Annals of Emergency Medicine, 45(2), 110-7.
Bayley MD, et al. The Financial Burden of Emergency Department Congestion and Hospital Crowding for Chest Pain Patients Awaiting Admission. Ann Emerg Med. 2005;45(2):110-7. PubMed PMID: 15671965.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The financial burden of emergency department congestion and hospital crowding for chest pain patients awaiting admission. AU - Bayley,Matthew D, AU - Schwartz,J Sanford, AU - Shofer,Frances S, AU - Weiner,Mark, AU - Sites,Frank D, AU - Traber,K Bobbi, AU - Hollander,Judd E, PY - 2005/1/27/pubmed PY - 2005/3/4/medline PY - 2005/1/27/entrez SP - 110 EP - 7 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 45 IS - 2 N2 - STUDY OBJECTIVE: We determined the additional cost of an extended emergency department (ED) length of stay for chest pain patients awaiting non-ICU, monitored (telemetry) beds. METHODS: This was a prospective cohort study of all ED chest pain patients aged 24 years or older and admitted to a telemetry bed in an urban university hospital during a 12-month period. Structured ED data collection included demographics, chest pain presentation, medical history, and laboratory test and ECG results. Hospital course was monitored daily, followed by a 30-day telephone follow-up. Risk severity scores (Goldman, Acute Cardiac Ischemia-Time-Insensitive Predictive Instrument, and Charlson) were calculated. Hospital charges, real costs, and revenues were obtained at discharge and 2 years later. The main outcome measure was risk-adjusted additional cost to the hospital of a delayed ED admission. Clinical outcome was a secondary measure. RESULTS: Of the 817 patients with chest pain presenting to the ED during the study period, there were 904 hospitalizations. Of these, 825 patients waited more than 3 hours for their bed (91%). There were 21 patient visits with a final diagnosis of acute myocardial infarction. ED length of stay was not associated with total hospital length of stay (r =0.01), hospital costs, or hospital or professional charges, revenues, or collection rates. The annual opportunity cost in lost hospital revenue for chest pain patients was 168,300 US dollars (204 US dollars per patient waiting >3 hours for a hospital bed). CONCLUSION: Extended ED length of stay demonstrated no association with total hospital costs or revenues or total hospital length of stay but imposed substantial ED opportunity costs, with decreased potential revenue. Interventions that reduce ED delays in hospital admissions have the potential to significantly increase hospital revenues. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/15671965/The_financial_burden_of_emergency_department_congestion_and_hospital_crowding_for_chest_pain_patients_awaiting_admission_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196064404013575 DB - PRIME DP - Unbound Medicine ER -