Lost capacity in emergency departments and its economic implications: A simulation study and economic analysis.

Abstract

To determine the effect of lost bed capacity (LBC) on the overall capacity of an ED, and to estimate the costs attributable to excess stay in the ED beyond that required for actual emergency care. This was a retrospective simulation and health economic evaluation, using data from a single-centre tertiary level ED. Data from all patients who presented to the ED during a 1-month period and triaged to receive an acute bed in order to undergo their emergency care were included. The main outcomes measured were the change in overall ED length of stay, and costs attributable to LBC, in both discharged and admitted patients. Overall daily median ED length of stay decreased by 182 min (95% confidence interval 165-198; P < 0.01) in the simulated cohort when LBC was removed. Within the admitted cohort, the median cost attributable to LBC was AUD$202.99 (95% confidence interval $186.50-$216.70) per patient. We estimate the cost of an ED bed to be AUD$164.59 per hour. A substantial amount of ED length of stay is due to patients remaining in the ED for time after their emergency care is concluded. This likely represents a substantial overall monetary cost to the Australian healthcare system.