Emergency Medical Minute15 Marras 2024

Episode 930: Holding Costs

Contributor: Aaron Lessen MD

Educational Pearls:

A study evaluated the patient-care impact and financial costs of holding patients in the ED, a nationwide issue

Prospective, observational study of acute stroke management
Conducted at a large urban, comprehensive stroke center

The study evaluated patients in multiple categories:

admitted to med/surg
admitted to med/surg but held in the ED
admitted to the ICU
Admitted to ICU but held in the ED

Examined the amount of time nurses and providers spent with each patient

This was analyzed in conjunction with the knowledge of each providers' salaries and the overhead costs of the med/surg unit, ICU, and ED

Conclusions:

Patients who required med/surg inpatient care but who were held in the ED resulted in a doubled daily cost

$1856 for med/surg inpatient boarding vs $993 for med/surg inpatient care

Patients who required ICU care but who were held in the ED also resulted in an increased daily cost, but this difference was not as large

$2267 for ICU inpatient boarding vs $2165 for ICU care

Holding in the ED negatively impacts patients since they receive less time from providers
Holding also results in increased financial costs

References

Canellas MM, Jewell M, Edwards JL, Olivier D, Jun-O'Connell AH, Reznek MA. Measurement of Cost of Boarding in the Emergency Department Using Time-Driven Activity-Based Costing. Annals of emergency medicine. Published online May 1, 2024. doi:https://doi.org/10.1016/j.annemergmed.2024.04.012

Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3

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