The development and validation of a resource consumption score of an emergency department consultation

Abstract

Background Emergency Department (ED) visits and health care costs are increasing globally, but little is known about contributing factors of ED resource consumption. This study aims to analyse and to predict the total ED resource consumption out of the patient and consultation characteristics in order to execute performance analysis and evaluate quality improvements. Methods Characteristics of ED visits of a large Swiss university hospital were summarized according to acute patient condition factors (e.g. chief complaint, resuscitation bay use, vital parameter deviations), chronic patient conditions (e.g. age, comorbidities, drug intake), and contextual factors (e.g. night-time admission). Univariable and multivariable linear regression analyses were conducted with the total ED resource consumption as the dependent variable. Results In total, 164,729 visits were included in the analysis. Physician resources accounted for the largest proportion (54.8%), followed by radiology (19.2%), and laboratory work-up (16.2%). In the multivariable final model, chief complaint had the highest impact on the total ED resource consumption, followed by resuscitation bay use and admission by ambulance. The impact of age group was small. The multivariable final model was validated (R2 of 0.54) and a scoring system was derived out of the predictors. Conclusions More than half of the variation in total ED resource consumption can be predicted by our suggested model in the internal validation, but further studies are needed for external validation. The score developed can be used to calculate benchmarks of an ED and provides leaders in emergency care with a tool that allows them to evaluate resource decisions and to estimate effects of organizational changes.

Clinical Presentations of Adolescents Aged 16–18 Years in the Adult Emergency Department

“…Patients with psychiatric problems should be carefully triaged, and specialists should be consulted at an early stage [ 2 ]. Our emergency centre is continuously committed to optimising processes based on resource analysis of specific patient populations [ 4 , 33 , 34 , 35 ]. This should continue in relation to the particularly vulnerable population of adolescent patients.…”

“…Data were extracted from the ED electronic medical record system (E.care BVBA, ED 2.1.3.0, Turnhout, Belgium) and included: demographics, triage category, mode of arrival, type of ED admission and discharge, and the principal complaint. We grouped principal complaints according to the resource consumption score of an emergency department consultation [ 4 ].…”

“…Consultations to the ED are rising in most Western countries [ 1 , 2 , 3 ]; in our emergency department (ED), the increase between 2013 and 2019 was 32% (38,027 cases in 2013 and 50,033 cases in 2019) [ 4 , 5 ].…”

A dangerously underrated entity? Non-specific complaints at emergency department presentation are associated with utilisation of less diagnostic resources

“…EDs serve as important points of entry to the health care system and are a pivotal source of medical care. As expected, utilisation of ED diagnostic resources (and the corresponding costs) increases with both age [ 20 ] and symptom severity (triage level) [ 21 , 22 ].…”

Floorball Injuries Presenting to a Swiss Adult Emergency Department: A Retrospective Study (2013–2019)

“…Increasing healthcare costs are a worldwide problem. The number of visits to emergency rooms is also increasing worldwide, and in addition, ED (Emergency Medicine) care is more expensive than other forms of health service [19,20]. Lamprecht et al calculated that the costs of physical activity and well-being in Switzerland are a mean of CHF 2100 per case [21].…”