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The Economics of an Admissions Holding Unit.
West J Emerg Med. 2017 Jun; 18(4):553-558.WJ

Abstract

INTRODUCTION

With increasing attention to the actual cost of delivering care, return-on-investment calculations take on new significance. Boarded patients in the emergency department (ED) are harmful to clinical care and have significant financial opportunity costs. We hypothesize that investment in an admissions holding unit for admitted ED patients not only captures opportunity cost but also significantly lowers direct cost of care.

METHODS

This was a three-phase study at a busy urban teaching center with significant walkout rate. We first determined the true cost of maintaining a staffed ED bed for one patient-hour and compared it to alternative settings. The opportunity cost for patients leaving without being seen was then conservatively estimated. Lastly, a convenience sample of admitted patients boarding in the ED was observed continuously from one hour after decision-to-admit until physical departure from the ED to capture a record of every interaction with a nurse or physician.

RESULTS

Personnel costs per patient bed-hour were $58.20 for the ED, $24.80 for an inpatient floor, $19.20 for the inpatient observation unit, and $10.40 for an admissions holding area. An eight-bed holding unit operating at practical capacity would free 57.4 hours of bed space in the ED and allow treatment of 20 additional patients. This could yield increased revenues of $27,796 per day and capture opportunity cost of $6.09 million over 219 days, in return for extra staffing costs of $218,650. Analysis of resources used for boarded patients was determined by continuous observation of a convenience sample of ED-boarded patients, which found near-zero interactions with both nursing and physicians during the boarding interval.

CONCLUSION

Resource expense per ED bed-hour is more than twice that in non-critical care inpatient units. Despite the high cost of available resources, boarded non-critical patients receive virtually no nursing or physician attention. An admissions holding unit is remarkably effective in avoiding the mismatch of the low-needs patients in high-cost care venues. Return on investment is enormous, but this assumes existing clinical space for this unit.

Authors+Show Affiliations

Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania.Temple University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28611873

Citation

Schreyer, Kraftin E., and Richard Martin. "The Economics of an Admissions Holding Unit." The Western Journal of Emergency Medicine, vol. 18, no. 4, 2017, pp. 553-558.
Schreyer KE, Martin R. The Economics of an Admissions Holding Unit. West J Emerg Med. 2017;18(4):553-558.
Schreyer, K. E., & Martin, R. (2017). The Economics of an Admissions Holding Unit. The Western Journal of Emergency Medicine, 18(4), 553-558. https://doi.org/10.5811/westjem.2017.4.32740
Schreyer KE, Martin R. The Economics of an Admissions Holding Unit. West J Emerg Med. 2017;18(4):553-558. PubMed PMID: 28611873.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Economics of an Admissions Holding Unit. AU - Schreyer,Kraftin E, AU - Martin,Richard, Y1 - 2017/05/01/ PY - 2016/10/03/received PY - 2017/04/10/revised PY - 2017/04/07/accepted PY - 2017/6/15/entrez PY - 2017/6/15/pubmed PY - 2018/3/7/medline SP - 553 EP - 558 JF - The western journal of emergency medicine JO - West J Emerg Med VL - 18 IS - 4 N2 - INTRODUCTION: With increasing attention to the actual cost of delivering care, return-on-investment calculations take on new significance. Boarded patients in the emergency department (ED) are harmful to clinical care and have significant financial opportunity costs. We hypothesize that investment in an admissions holding unit for admitted ED patients not only captures opportunity cost but also significantly lowers direct cost of care. METHODS: This was a three-phase study at a busy urban teaching center with significant walkout rate. We first determined the true cost of maintaining a staffed ED bed for one patient-hour and compared it to alternative settings. The opportunity cost for patients leaving without being seen was then conservatively estimated. Lastly, a convenience sample of admitted patients boarding in the ED was observed continuously from one hour after decision-to-admit until physical departure from the ED to capture a record of every interaction with a nurse or physician. RESULTS: Personnel costs per patient bed-hour were $58.20 for the ED, $24.80 for an inpatient floor, $19.20 for the inpatient observation unit, and $10.40 for an admissions holding area. An eight-bed holding unit operating at practical capacity would free 57.4 hours of bed space in the ED and allow treatment of 20 additional patients. This could yield increased revenues of $27,796 per day and capture opportunity cost of $6.09 million over 219 days, in return for extra staffing costs of $218,650. Analysis of resources used for boarded patients was determined by continuous observation of a convenience sample of ED-boarded patients, which found near-zero interactions with both nursing and physicians during the boarding interval. CONCLUSION: Resource expense per ED bed-hour is more than twice that in non-critical care inpatient units. Despite the high cost of available resources, boarded non-critical patients receive virtually no nursing or physician attention. An admissions holding unit is remarkably effective in avoiding the mismatch of the low-needs patients in high-cost care venues. Return on investment is enormous, but this assumes existing clinical space for this unit. SN - 1936-9018 UR - https://www.unboundmedicine.com/medline/citation/28611873/The_Economics_of_an_Admissions_Holding_Unit_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28611873/ DB - PRIME DP - Unbound Medicine ER -