"With 44 million uninsured Americans, hospital emergency departments provide a great deal of uncompensated care as the nation's health care safety net," said Judd E. Hollander, MD, with the University of Pennsylvania and one of the study authors. "With the constant pressure to minimize health care costs and frequent reimbursement changes that reduce funds for uncompensated care, it is critical that hospitals adopt interventions to more efficiently move admitted emergency department patients into inpatient beds. This would free up emergency department beds for incoming patients."
To determine whether long waits for inpatient beds impact hospital revenue, emergency medicine researchers at the University of Pennsylvania chose to examine chest pain patients, because their care in the emergency department is standardized and they are frequently admitted to telemetry beds, which are hospital beds equipped to monitor a cardiac patient's condition.
Of the 904 visits made by chest pain patients to an urban emergency department between Oct. 1, 1999 and Sept. 30, 2000, 91 percent (825) waited greater than 3 hours for a telemetry bed to become available in the hospital. Patients who sought care on weekdays had longer lengths of stay in the emergency department--2 hours longer on average--than patients seeking care on weekends, the study found.
Researchers attribute the long waits to the shortage of inpatient telemetry beds, which other studies have confirmed as a nationwide problem. Possible reasons researchers give for the shortage of inpatient beds include shift changes, beds being held for elective surgery patients (especially on weekdays), physicians making rounds late in the day, or inadequate turnover of beds by housekeeping.
While the study found chest pain patients' length of stay in the emergency department had no association with their health outcome, total hospital length of stay or health system cost or revenues, these standard accounting measures miss half the problem in that they ignore the missed opportunity for emergency medical staff to treat another patient, according to the study's authors.
To calculate potential lost revenue, researchers used the average payment collected for each emergency patient treated in an urban emergency department--about 30 cents to the dollar--as opposed to the average amount billed. They found hospitals are potentially losing in excess of $168,000 in potential revenue because admitted chest pain patients waiting for telemetry beds block emergency department beds that could be used to treat incoming patients.
"If similar extended lengths of stay exist in the care of all admitted emergency department patients, the hospital may be losing more than $1.74 million in potential revenue each year," said Dr. Hollander. "However, we believe this is an underestimation, because our study did not include lost revenue from patients who left without being seen, patients in ambulances diverted to other emergency departments, or patients who avoided the emergency department based on the wait time or its wait time reputation."
Annals of Emergency Medicine is the peer-reviewed journal of the American College of Emergency Physicians, a national medical organization with more than 23,000 members. ACEP is committed to improving the quality of emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia, and a Government Services Chapter representing emergency physicians employed by military branches and other government agencies.
Journal
Annals of Emergency Medicine