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Societal savings by "fast tracking" lower acuity patients in an urban pediatric emergency department
H K Simon1, D A Ledbetter, J Wright
1Department of Pediatrics, Egleston Children's Hospital, Emory University School of Medicine, Atlanta, GA 30322, USA.
Insights
A fast track system for pediatric emergency departments significantly reduces costs for society by diverting lower acuity patients. This system saves an average of $25 per patient, improving patient flow and hospital revenue negotiations.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Healthcare Economics
Background:
- Pediatric emergency departments (EDs) face challenges managing patient flow and costs.
- Diverting lower acuity patients to a specialized area may improve efficiency.
Purpose of the Study:
- To evaluate the cost-effectiveness of a fast track system for low-acuity pediatric ED patients.
- To determine societal savings and impact on hospital revenue.
Main Methods:
- Retrospective analysis of 4,060 fast track patients and 5,199 main ED patients with common diagnoses.
- Comparison of demographics, acuity, diagnosis, charges, and collection ratios.
- Calculation of societal savings based on revenue differences and patient volume.
Main Results:
- Fast track patients incurred significantly lower average charges (1:2.4 ratio) and net revenue (1:2.6 ratio) compared to main ED patients.
- Societal savings amounted to $101,313, averaging $25 per fast track patient.
- Collection ratios were comparable between the fast track and main ED groups (57% vs. 62%).
Conclusions:
- A fast track system is cost-effective, generating significant societal savings.
- This system enhances patient flow and can aid hospitals in payor negotiations by reducing charges.
- Fast track systems offer a strategy to maintain departmental revenue amidst changing payor policies for low-acuity ED visits.
Abstract:
To evaluate the cost-effectiveness of a "fast track" system for diverting lower acuity patients away from the pediatric emergency department (ED), 4,060 patients triaged to the fast track area of an urban pediatric ED with the 10 most common discharge diagnoses from 1/1/94 through 12/31/94 were retrospectively evaluated. Patients triaged as having nonurgent concerns qualified for treatment in a separate fast track area for 8 hours per day (fast track patients). These patients were compared with 5,199 seen in the main pediatric ED for the same concerns during the remaining hours when the fast track was not in operation (ED patients). Computer records were reviewed for demographics, acuity levels, diagnosis, and collection ratios (revenues/charges). The societal savings was calculated as sigma $ [(delta mean revenue of diagnosis1-10 in the main ED - mean revenue of diagnosis1-10 in the fast track) x the number of patients seen in fast track for diagnosis1-10] stratified by acuity. Collection ratios were comparable between groups (57% v 62%), but the average charges (physician and facility) were significantly less for patients seen in the fast track by a ratio of 1:2.4 (P < .0001). The average net revenue was also significantly less for all patients seen in the fast track by a ratio of 1:2.6 (P < .0001). When stratified by diagnosis and acuity, the savings to society was $101,313, or an average of $25/patient seen in the fast track ($101,313 per 4,060). A fast track is an effective system for maintaining patient flow at a cost savings to society. It can help the hospital in its negotiations with payors because it curtails charges. It is also a potential means for maintaining overall departmental revenues as payors increasingly deny traditional pediatric ED visits for patients with lower acuity concerns.