The Opportunity Loss of Boarding Admitted Patients in the Emergency Department

Falvo, Thomas; Grove, Lance; Stachura, Ruth; Vega, David; Stike, Rose; Schlenker, Melissa; Zirkin, William

doi:10.1197/j.aem.2006.11.011

Cited by 89 publications

(71 citation statements)

References 45 publications

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“…4,5 Despite recent expansion of health insurance coverage, ED visit volumes are expected to grow, exacerbating ED crowding and LWBS rates. 6 The financial effect of crowding on the costs of ED visits has been previously estimated, [7][8][9][10] but has been limited to hospital (i.e., facility) reimbursement 9,11,12 or patients with disease-specific conditions (e.g., chest pain 13 ) or has considered only the revenue opportunity loss from ambulance diversion. 12,14,15 Few studies have attempted to estimate the lost revenue opportunity from patients who LWBS.…”

mentioning

confidence: 99%

Emergency Severity Index Triage System Correlation with Emergency Department Evaluation and Management Billing Codes and Total Professional Charges

Wiler

Poirier

Farley

et al. 2011

Academic Emergency Medicine

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Objectives: All services provided by physicians to patients during an emergency department (ED) visit, including procedures and ''cognitive work,'' are described by common procedural terminology (CPT) codes that are translated by coders into total professional (physician) charges for the visit. These charges do not include the technical (facility) charges. The objectives of this study were to characterize associations between Emergency Severity Index (ESI) acuity level, ED Evaluation and Management (E&M) billing codes 99281-99285 and 99291, and total ED provider charges (sum of total procedure and E&M professional charges). Secondary objectives were to identify factors that might affect these associations and to evaluate the performance of ESI and identified variables to predict E&M code and average total professional charges. Methods:The authors reviewed 276,824 patient records for calendar year 2007, of which 193,952 adult ED visits from three different ED types (community, university-based academic, and non-universitybased academic) met inclusion criteria. Correlations between 1) ESI level and E&M billing code per visit by institution and 2) ESI and total professional charges were analyzed using Spearman rank correlation. Linear regression analysis was performed to identify variables that significantly affected these correlations.Results: ESI level and E&M codes were moderately correlated (Spearman r = 0.51). ESI levels corresponded proportionately to higher E&M codes. ESI 1, 2, and 3 most frequently corresponded with E&M level 5 (50, 62, and 45%, respectively), and ESI 4 and 5 most frequently corresponded with E&M level 3 (56 and 67%, respectively). Only age by decade significantly affected the association between ESI level and E&M billing code. The mean total professional charge for all patient encounters was $421 (SD ± $204) with increasing mean charges per patient by increasing ESI acuity. Race and E&M code significantly affected the relationship between ESI level and total ED professional charges per patient (adjusted r 2 = 0.66).Conclusions: A moderate, nonlinear correlation exists between ESI acuity levels and ED E&M billing codes. Increasing age affects this correlation. Race and E&M code affect the correlation between ESI level and total professional charges. As such, basic triage data can be used to estimate E&M code and total professional charges. Future studies are needed to validate these findings across other institutional settings.

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confidence: 99%

Emergency Severity Index Triage System Correlation with Emergency Department Evaluation and Management Billing Codes and Total Professional Charges

Wiler

Poirier

Farley

et al. 2011

Academic Emergency Medicine

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“…3 Downstream effects include ED crowding and compromised capability to provide quality and timely care to other patients. 13,21 One of the responsibilities of an academic medical center is to provide equitable access to transfer requests from other hospitals, acting as a regional safety net providing specialized advanced healthcare services. 1 Patients who transfer to a tertiary care ICU generally have higher mortality than directly admitted patients, but this difference dissipates after adjusting for severity of illness.…”

Section: Discussionmentioning

confidence: 99%

“…"Boarding time" in the ED was defined as the timebetween when the ED physician noted the decision to admit the patient (bed control had called the admitting team) and the time of the patient's departure from the ED. While some ED literature suggests that a two hour delay has negative clinical implications 13 , based on critical care clinical experience, boarding time was dichotomized at 4 hours. For each ICU admission from the ED, we computed whether the ED boarding time exceeded four hours.…”

Section: Opportunity Cost Evaluationmentioning

confidence: 99%

The Opportunity Cost of Futile Treatment in the Intensive Care Unit

Huynh¹,

Raj²,

Kleerup³

et al. 2013

Chest

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“…Patients that have been discharged from the ED (i.e., they have finished the treatment phase) either leave the ED immediately or undergo another waiting phase; boarding. While patients remain blocked or boarded in an ED bed, they prevent other patients from seizing an ED bed and starting treatment which might lead to ambulance diversion [8], a higher mortality rate [5], higher left-without-being seen (LWBS) rates, and lower profits for the hospital [4].…”

Section: Dss Componentsmentioning

confidence: 99%

“…Following [2], we chose to use the term 'crowding' in this article. Crowding has received attention since the early '90s in the medical literature (see, e.g., [1][2][3][4][5]) and in the field of Operations Research and Operations Management [6,7]. Simultaneously, there is increasing pressure on EDs to improve their operational performance, and decrease the length of stay (LOS) of patients in the ED [6].…”

Section: Introductionmentioning

confidence: 99%

A Decision Support System for Capacity Planning in Emergency Departments

Carmen¹,

Defraeye²,

Nieuwenhuyse³

2015

Int. j. simul. model.

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In this article, we present a decision support system (DSS) for improving patient flow in emergency departments (EDs). The core of the system is a discrete-event simulation (DES) model that aims to support capacity planning in the ED, in view of controlling patients' length of stay (LOS). Conceptually, it regards the patient LOS as the result of different queueing systems, the behaviour of which is influenced by different types of capacities. Taking inputs from ED patient record data, the DSS allows to analyse the impact of different capacity changes on patient flow, and to detect efficient capacity combinations using data envelopment analysis (DEA). We report on the insights obtained from a case study in a large regional hospital in Belgium.

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The Opportunity Loss of Boarding Admitted Patients in the Emergency Department

Abstract: Significantly higher operational revenues could be generated by reducing output delays that restrict optimal utilization of existing ED treatment capacity.

Cited by 89 publications

References 45 publications

Emergency Severity Index Triage System Correlation with Emergency Department Evaluation and Management Billing Codes and Total Professional Charges

Emergency Severity Index Triage System Correlation with Emergency Department Evaluation and Management Billing Codes and Total Professional Charges

The Opportunity Cost of Futile Treatment in the Intensive Care Unit

A Decision Support System for Capacity Planning in Emergency Departments

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