Because of this, the emergency department loses at least seven more patients a day than the average emergency department, or 2,555 patients a year. At that pace, the direct ED revenue is $2.5 million less than it could be just from patients known to be leaving before treatment completion. At an average admission rate, about 537 of those patients would have been admitted—even more if extended boarding times force the emergency department to go on ambulance diversion. The lost admissions would have contributed another $3.2 million to the constipated hospital’s average direct revenue.

The bottom line is that total revenue loss for the constipated hospital is about $15,500 a day compared to the average emergency department. The loss of that many patients and that much revenue should force C-suite leaders to sit down with the inpatient units to find solutions for the rapid transportation of 40 patients a day to the inpatient units. Efficient hospital patient processing could expand that number to 44 patients a day.

Emergency departments that work to reduce patient boarding to less than the national average of 109 minutes show even greater benefits. Reducing ED boarding time from 147 minutes to about 92 minutes reduces walkaway rates from an average of 3.2 percent to 2.1 percent. Decreasing walkaway rates by two patients a day and increasing admissions by one more patient every three days will have a financial impact over the year of $1.5 million, or a little more than $4,000 a day.

Financial benefits extend beyond these examples. The above analyses don’t factor in the cost of improved ED staff retention, improved ED patient care experience, and improved compliance with inpatient protocols, all of which reduce inpatient costs.

There are substantial impacts of boarding on the financial performance of emergency departments, beyond the cost of stress to patients, their families, the emergency physician, and ED nurses and support staff. It’s critical for hospital leaders to improve the flow of admitted patients.

References

1. Augustine JJ. Reducing boarding time in the emergency department can improve patient care. ACEP Now. 2015;34(12);9.
2. Owens P, Elixhauser A. Hospital Admissions That Began in the Emergency Department, 2003. Statistical Brief #1. Rockville, Md.: Agency for Healthcare Research and Quality; February 2006.
3. Medicare Expenditure Panel Survey. Agency for Healthcare Research and Quality website. Accessed June 9, 2016.
4. MEPS HC-160E: 2013 Emergency Room Visits File. Agency for Healthcare Research and Quality website. Accessed June 9, 2016.