A Hospitalist-Led Team to Manage Patient Boarding in the Emergency Department: Impact on Hospital Length of Stay and Cost
Admitted patients boarding in the emergency department (ED) while awaiting inpatient beds represent a bottleneck in patient flow. We sought to examine the impact on patient flow and potential for cost savings by an active management of boarded ED medical admissions by a hospitalist-led team, which i...
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Published in | Southern medical journal (Birmingham, Ala.) Vol. 112; no. 12; p. 599 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
01.12.2019
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Abstract | Admitted patients boarding in the emergency department (ED) while awaiting inpatient beds represent a bottleneck in patient flow. We sought to examine the impact on patient flow and potential for cost savings by an active management of boarded ED medical admissions by a hospitalist-led team, which included a hospitalist, an advanced practitioner, and a case manager.
This was a retrospectively conducted analysis of a quality improvement pilot intervention implemented at a large tertiary center. We analyzed patients admitted under observation status between April 1, 2016 and June 30, 2016. We calculated the difference for length of stay (in hours) and direct cost between patients in the intervention group and a usual care group from a similar time period in the prior year matched on the all patients refined-diagnosis related groups (APR-DRG) and severity of illness (SOI) level.
One hundred seventy-five observation patients were managed by the hospitalist team during the 3-month pilot period. This group had an average hospital stay of 26.0 hours compared with 29.7 hours in the usual care group. Direct costs resulted in the following results: average cost for the intervention patient group $1452 (±$775) versus $2524 (±$894) group, for an average savings of $1072 (
< 0.001), with a total estimated direct cost savings of $187,660.
Active management of ED boarding patients by a hospitalist-led team is feasible and can lead to hospital cost savings and decrease in hospital stay. The findings from this pilot resulted in a decision to make the ED hospitalist-led team permanent in our institution. The evaluation of the program may help other hospitals to decide whether this intervention is worth pursuing in their own organization. |
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AbstractList | Admitted patients boarding in the emergency department (ED) while awaiting inpatient beds represent a bottleneck in patient flow. We sought to examine the impact on patient flow and potential for cost savings by an active management of boarded ED medical admissions by a hospitalist-led team, which included a hospitalist, an advanced practitioner, and a case manager.
This was a retrospectively conducted analysis of a quality improvement pilot intervention implemented at a large tertiary center. We analyzed patients admitted under observation status between April 1, 2016 and June 30, 2016. We calculated the difference for length of stay (in hours) and direct cost between patients in the intervention group and a usual care group from a similar time period in the prior year matched on the all patients refined-diagnosis related groups (APR-DRG) and severity of illness (SOI) level.
One hundred seventy-five observation patients were managed by the hospitalist team during the 3-month pilot period. This group had an average hospital stay of 26.0 hours compared with 29.7 hours in the usual care group. Direct costs resulted in the following results: average cost for the intervention patient group $1452 (±$775) versus $2524 (±$894) group, for an average savings of $1072 (
< 0.001), with a total estimated direct cost savings of $187,660.
Active management of ED boarding patients by a hospitalist-led team is feasible and can lead to hospital cost savings and decrease in hospital stay. The findings from this pilot resulted in a decision to make the ED hospitalist-led team permanent in our institution. The evaluation of the program may help other hospitals to decide whether this intervention is worth pursuing in their own organization. |
Author | Donovan, Ashley Visintainer, Paul Tiwari, Vishal Stefan, Mihaela S Hrycko, Alexander Scibelli, Christine Vemula, Michael Joshi, Kirti |
Author_xml | – sequence: 1 givenname: Alexander surname: Hrycko fullname: Hrycko, Alexander organization: From the Department of Medicine, Division of Hospital Medicine, the Department of Finance, and The Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield – sequence: 2 givenname: Vishal surname: Tiwari fullname: Tiwari, Vishal organization: From the Department of Medicine, Division of Hospital Medicine, the Department of Finance, and The Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield – sequence: 3 givenname: Michael surname: Vemula fullname: Vemula, Michael organization: From the Department of Medicine, Division of Hospital Medicine, the Department of Finance, and The Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield – sequence: 4 givenname: Ashley surname: Donovan fullname: Donovan, Ashley organization: From the Department of Medicine, Division of Hospital Medicine, the Department of Finance, and The Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield – sequence: 5 givenname: Christine surname: Scibelli fullname: Scibelli, Christine organization: From the Department of Medicine, Division of Hospital Medicine, the Department of Finance, and The Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield – sequence: 6 givenname: Kirti surname: Joshi fullname: Joshi, Kirti organization: From the Department of Medicine, Division of Hospital Medicine, the Department of Finance, and The Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield – sequence: 7 givenname: Paul surname: Visintainer fullname: Visintainer, Paul organization: From the Department of Medicine, Division of Hospital Medicine, the Department of Finance, and The Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield – sequence: 8 givenname: Mihaela S surname: Stefan fullname: Stefan, Mihaela S organization: From the Department of Medicine, Division of Hospital Medicine, the Department of Finance, and The Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield |
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Snippet | Admitted patients boarding in the emergency department (ED) while awaiting inpatient beds represent a bottleneck in patient flow. We sought to examine the... |
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SubjectTerms | Crowding Emergency Service, Hospital Hospital Bed Capacity Hospitalists Humans Length of Stay - economics Massachusetts Patient Admission Patient Care Team - organization & administration Patient Readmission - statistics & numerical data Pilot Projects Retrospective Studies |
Title | A Hospitalist-Led Team to Manage Patient Boarding in the Emergency Department: Impact on Hospital Length of Stay and Cost |
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