Operational and financial impact of physician screening in the ED
Operational and financial impact of physician screening in the ED
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DOI：
10.1016/j.ajem.2011.01.024
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发表时间：
2012-05-01
影响因子：
3.6
通讯作者：
Brown, David F. M.
中科院分区：
文献类型：
--
作者：
Soremekun, Olanrewaju A.;Biddinger, Paul D.;Brown, David F. M.
背景：医生筛查是为提高急诊科效率而实施的众多前端干预措施之一。研究目标：我们旨在量化这种干预措施在城市三级学术中心的运营和财务影响。方法：我们对城市三级学术中心的医生筛查系统进行了为期两年的事前和事后分析，年就诊人数为9万人次。财务影响包括急诊室和住院患者因容量增加而产生的收入，以及留下看不见(LWBS)费率的降低。ED和住院保证金的贡献以及资本支出是基于现有的公布数据。我们使用未来现金流量的净现值对财务影响进行了总结，并对假设进行了敏感性分析。结果：在第一年，我们估计筛查系统的贡献幅度为271万美元，增加的运营成本为186万美元。该系统的估计非经常开支为120万元。这笔投资的净现值为282万美元，从最初投资到盈亏平衡的时间是13个月。在操作上，尽管病人数量增加了16.7%，登机时间没有减少，急诊室的住院时间减少了7.4%，LWBS从3.3%减少到1.8%。结论：除了改进操作措施外，急诊室医生筛选计划的实施还允许增加患者护理能力，从而产生总体积极的财务影响。(C)2012 Elsevier Inc.保留所有权利。
Background: Physician screening is one of many front-end interventions being implemented to improve emergency department (ED) efficiency.Study objective: We aimed to quantify the operational and financial impact of this intervention at an urban tertiary academic center.Methods: We conducted a 2-year before-after analysis of a physician screening system at an urban tertiary academic center with 90 000 annual visits. Financial impact consisted of the ED and inpatient revenue generated from the incremental capacity and the reduction in left without being seen (LWBS) rates. The ED and inpatient margin contribution as well as capital expenditure were based on available published data. We summarized the financial impact using net present value of future cash flows performing sensitivity analysis on the assumptions. Operational outcome measures were ED length of stay and percentage of LWBS.Results: During the first year, we estimate the contribution margin of the screening system to be $2.71 million and the incremental operational cost to be $1.86 million. Estimated capital expenditure for the system was $1 200 000. The NPV of this investment was $2.82 million, and time to break even from the initial investment was 13 months. Operationally, despite a 16.7% increase in patient volume and no decrease in boarding hours, there was a 7.4% decrease in ED length of stay and a reduction in LWBS from 3.3% to 1.8%.Conclusions: In addition to improving operational measures, the implementation of a physician screening program in the ED allowed for an incremental increase in patient care capacity leading to an overall positive financial impact. (C) 2012 Elsevier Inc. All rights reserved.