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The financial consequences of lost demand and reducing boarding in hospital emergency departments.
Ann Emerg Med. 2011 Oct; 58(4):331-40.AE

Abstract

STUDY OBJECTIVE

Some have suggested that emergency department (ED) boarding is prevalent because it maximizes revenue as hospitals prioritize non-ED admissions, which reimburse higher than ED admissions. We explore the revenue implications to the overall hospital of reducing boarding in the ED.

METHODS

We quantified the revenue effect of reducing boarding-the balance of higher ED demand and the reduction of non-ED admissions-using financial modeling informed by regression analysis and discrete-event simulation with data from 1 inner-city teaching hospital during 2 years (118,000 ED visits, 22% ED admission rate, 7% left without being seen rate, 36,000 non-ED admissions). Various inpatient bed management policies for reducing non-ED admissions were tested.

RESULTS

Non-ED admissions generated more revenue than ED admissions ($4,118 versus $2,268 per inpatient day). A 1-hour reduction in ED boarding time would result in $9,693 to $13,298 of additional daily revenue from capturing left without being seen and diverted ambulance patients. To accommodate this demand, we found that simulated management policies in which non-ED admissions are reduced without consideration to hospital capacity (ie, static policies) mostly did not result in higher revenue. Many dynamic policies requiring cancellation of various proportions of non-ED admissions when the hospital reaches specific trigger points increased revenue. The optimal strategies tested resulted in an estimated $2.7 million and $3.6 in net revenue per year, depending on whether left without being seen patients were assumed to be outpatients or mirrored ambulatory admission rates, respectively.

CONCLUSION

Dynamic inpatient bed management in inner-city teaching hospitals in which non-ED admissions are occasionally reduced to ensure that EDs have reduced boarding times is a financially attractive strategy.

Authors+Show Affiliations

Departments of Emergency Medicine and Health Policy, George Washington University, Washington, DC 20037, USA. jesse.pines@gmail.comNo 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

21514004

Citation

Pines, Jesse M., et al. "The Financial Consequences of Lost Demand and Reducing Boarding in Hospital Emergency Departments." Annals of Emergency Medicine, vol. 58, no. 4, 2011, pp. 331-40.
Pines JM, Batt RJ, Hilton JA, et al. The financial consequences of lost demand and reducing boarding in hospital emergency departments. Ann Emerg Med. 2011;58(4):331-40.
Pines, J. M., Batt, R. J., Hilton, J. A., & Terwiesch, C. (2011). The financial consequences of lost demand and reducing boarding in hospital emergency departments. Annals of Emergency Medicine, 58(4), 331-40. https://doi.org/10.1016/j.annemergmed.2011.03.004
Pines JM, et al. The Financial Consequences of Lost Demand and Reducing Boarding in Hospital Emergency Departments. Ann Emerg Med. 2011;58(4):331-40. PubMed PMID: 21514004.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The financial consequences of lost demand and reducing boarding in hospital emergency departments. AU - Pines,Jesse M, AU - Batt,Robert J, AU - Hilton,Joshua A, AU - Terwiesch,Christian, Y1 - 2011/04/22/ PY - 2010/11/16/received PY - 2011/02/10/revised PY - 2011/03/01/accepted PY - 2011/4/26/entrez PY - 2011/4/26/pubmed PY - 2011/12/13/medline SP - 331 EP - 40 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 58 IS - 4 N2 - STUDY OBJECTIVE: Some have suggested that emergency department (ED) boarding is prevalent because it maximizes revenue as hospitals prioritize non-ED admissions, which reimburse higher than ED admissions. We explore the revenue implications to the overall hospital of reducing boarding in the ED. METHODS: We quantified the revenue effect of reducing boarding-the balance of higher ED demand and the reduction of non-ED admissions-using financial modeling informed by regression analysis and discrete-event simulation with data from 1 inner-city teaching hospital during 2 years (118,000 ED visits, 22% ED admission rate, 7% left without being seen rate, 36,000 non-ED admissions). Various inpatient bed management policies for reducing non-ED admissions were tested. RESULTS: Non-ED admissions generated more revenue than ED admissions ($4,118 versus $2,268 per inpatient day). A 1-hour reduction in ED boarding time would result in $9,693 to $13,298 of additional daily revenue from capturing left without being seen and diverted ambulance patients. To accommodate this demand, we found that simulated management policies in which non-ED admissions are reduced without consideration to hospital capacity (ie, static policies) mostly did not result in higher revenue. Many dynamic policies requiring cancellation of various proportions of non-ED admissions when the hospital reaches specific trigger points increased revenue. The optimal strategies tested resulted in an estimated $2.7 million and $3.6 in net revenue per year, depending on whether left without being seen patients were assumed to be outpatients or mirrored ambulatory admission rates, respectively. CONCLUSION: Dynamic inpatient bed management in inner-city teaching hospitals in which non-ED admissions are occasionally reduced to ensure that EDs have reduced boarding times is a financially attractive strategy. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/21514004/The_financial_consequences_of_lost_demand_and_reducing_boarding_in_hospital_emergency_departments_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(11)00206-X DB - PRIME DP - Unbound Medicine ER -