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: 

1. admitted to med/surg

2. admitted to med/surg but held in the ED

3. admitted to the ICU

4. 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

1. 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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