Just a Minute: The Effect of Emergency Department Wait Time on the Cost of Care

Abstract

Wait times are rising in U.S. emergency departments (EDs). The longer a patient waits to be seen, the more their condition may worsen. Notably, patients in worse condition can cost more to care for. This study estimates the effect of ED wait time on the cost of care by exploiting the quasi‐random assignment of patients to triage nurses in an instrumental variables framework. The results suggest that prolonging the wait of a patient who arrives with a serious condition by 10 minutes will increase the hospital's cost to care for the patient by an average of 6%. The magnitude of this effect dissipates (fading to zero) among patients who arrive with less serious conditions.(JEL D24, H41, I10)

The effects of unexpected changes in demand on the performance of emergency departments

“…In the event of unexpected increases in demand, physician responses (under fixed ED capacity) are therefore likely guided by a time‐quality trade‐off (Martins & Filipe, 2020). Patient health, as well as other important outcomes such as lower treatment costs, has been found to be increasing with greater time spent with patients (Chen, Farwell, & Jha, 2009) and reducing in waiting times for both elective care (Nikolova, Harrison, & Sutton, 2016) and ED care (Gruber, Hoe, & Stoye, 2018; Guttmann, Schull, Vermeulen, & Stukel, 2011; Woodworth & Holmes, 2020). Thus, in trying to maximize patient health in response to a demand increase, physicians must choose to either maintain waiting times through reducing the amount of time spent with patients (likely by rationing the volume and/or complexity of treatment); or maintaining the same volume/complexity of care and allowing waits to increase.…”

Impact of psychiatric social workers on length of stay in psychiatric emergency service

“…Utilizing nonmedical staff, such as social workers, to reduce LOS also alleviates financial burden on the health care system. Woodworth and Holmes 10 found that, for every 10‐min increase in LOS among patients presenting to the ED with severe conditions of high medical and psychiatric acuity combined (Emergency Severity Index Levels 1 and 2), the hospital's cost of care increased by 6%. Grover et al 11 found that implementing a case management program for frequent ED users resulted in a 39% decrease in LOS and a 41% decrease in hospital costs in both ED and inpatient settings, reducing total LOS of enrolled patients ( n = 158) by 178 days in a year leading to saving $5.8 million.…”

Modeling and Validation of the Hospital’s Ambulatory and Inpatients Operations Using a Non-Homogenous Discrete Time Markovian Chains

“…In the monthly published reports of the National Health Services [4], it is reported a rate of 4.9% as a mortality rate among ambulatory patients back in 2019. On a recent study published by the Economic injury [5], increased waiting times does not only have an impact on patient's condition but also on the hospital's cost to care those patients with an average of 6%. While in United States and according to the National Center for Health Statistics [6] a total number of 2 839 205 resident deaths were recorded in 2018.…”