Cost Benefit Analysis of Physician-in-Triage Model at Community Hospital Emergency Department

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Study Objectives: Crowding and long throughput times during peak hoursrepresent two problems that emergency departments (ED) increasingly face.Previous studies have shown that the physician-in-triage (PIT) model reduces waittimes, decreases length of stay, and increases staff satisfaction. In the communityhospital setting, we have previously described that incorporating the PIT modelsignificantly reduced door-to-doc time and length of stay. An additional benefitofthe PIT model is to directly increase gross revenue by decreasing the number ofpatients who leave without being seen (LWBS) and recapturing that revenue. Ourstudy objective was to compare the number of patients who LWBS before and afterimplementation of the PIT model during peak hours and calculate the resultantcosts/benefits.

Methods: From March 1st, 2016 to May 31st, 2016, we conducted aretrospective observational study of ED throughput data at a suburban communityhospital with an annual ED census of>95,000 visits per yer. During the studyperiod a PIT was added to the staffing model from 4-8PM, peak patient arrivaltimes. LWBS data was collected during this time and compared with historicalcontrol data from March 1st, 2015 to May 31st, 2015. Our primary outcomemeasure was to calculate the number of ED patients who LWBS before and afterPIT model implementation. Our secondary outcome was to conduct a cost benefitanalysis in conjunction with the hospitalfinance department to determine whetherthe PIT model was able to recaptured potential revenue by decreasing patients. Datawas analyzed using descriptive statistics.

Results: During the historical cohort a total of 169 patients LWBS. After the PITmodel was implemented the number of patients who LWBS decreased to 72, a57.4% change. Utilizing a conservative estimate, that patients who leave prior toevaluation typically represent low level 1 or 2 acuity cases, we estimated a potentialrevenue recapture of $130 per patient. Based on these numbers an estimated$12,610 was recaptured in revenue by the hospital as a result of implementing thePIT model. The cost of the additional staffing during the study period was$66,462.64 ($722.42 x 92 days). This results in a direct cost of $53,852.64 by thePIT model.

Conclusions: Implementation of a PIT model during peak hours significantlydecreases patients who LWBS, resulting in a direct increase in recaptured revenue. Inour study this revenue was not able to compensate for the cost of the additional staffingrequired.


American College of Emergency Physicians (ACEP) Research Forum,Washington DC, October 29-31, 2017.