Tuesday, July 21, 2009

Is the ED Cost Efficient?

Emergency medicine is a 24/7/365 day of the year service. The visits are not scheduled and ED's cannot hang up a sign on Friday afternoon that says, "Closed at 5 p.m. will open on Monday at 9:00 a.m." Our society has grown to understand that it is the only place in the nation where they can get around the clock assistance for "unscheduled and emergency care." And, other physicians, (both primary care and specialists) have found that out too. They also send their patients to the ED when they cannot provide for their patients' care during office hours or after office hours when the office is closed.

That said, ED's have been accused of not being "cost efficient" and "expensive." By the nature of the business, there is a basic operating cost to staff and operate an ED - equipment, personnel, etc. Barring volume, there is a certain amount of fixed costs regardless of whether there are 10 patients seen in a day or 20. Obviously, as volume increases, costs increase for personnel and equipment. So is it fair to say, that it is inefficient? I don't think so, since the ED is now the FRONT door to the hospital. Most hospitals have over 50% of the admission enter through the ED.

In fact, no longer do many hospitals have direct admissions, where patients come sick directly from home or a nursing home. Rather they come to the ED first to have further diagnostics testing and initiation of their treatment prior to being admitted to an inpatient bed. Years ago someone presented to the ED with abdominal pain, they may have had lab studies, x-rays and maybe admitted for observation or consultations and over the course of 2-3 days have a CT scan, further consultations, and other testing. But now, the same patient comes in and can spend 6-8 hours in an ED but the work-up is streamlined and a decision made to either safely send the patient home, send them home for further outpatient management and testing, or admit them to the hospital for further care that they cannot receive as an outpatient. A far cry from what happened years ago. Actually most of us would consider that MORE efficient and cost effective avoiding an even more expensive hospitalization.

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