ORIGINAL ARTICLE   Open access

Italian Journal of Emergency Medicine 2020 April;9(1):20-8

DOI: 10.23736/S2532-1285.20.00018-X

Copyright © 2020 THE AUTHORS

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language: English

Analysis of the costs of emergency room management of critically ill patients

Gabriele VALLI ¹ ✉, Paolo FRATINI ², Nicola VOLPE ³, Francesca DE MARCO ¹, Caterina PANDOLFI ¹, Carlo ANCONA ¹, Maria P. RUGGIERI ¹

¹ Department of Emergency, San Giovanni Addolorata Hospital, Rome, Italy; ² Department of Emergency, S. Andrea Hospital, Sapienza University, Rome, Italy; ³ George Eliot Hospital NHS Trust, Nuneaton, UK

BACKGROUND: The analysis of the factors that could influence the cost of care in Emergency department (ED) has never been appropriately quantified.
METHODS: We analyzed retrospectively 555 patients admitted for whatever reason in our resuscitation room (RR) during two months of observation, to assess the amount of resources utilized to care patients awaiting admission to high dependency care unit. For each patient, we recorded: general clinical data, discharge diagnosis, length of stay in ER (hours). Total intervention cost was calculated from the regional standard costs proceeding from the number and type of blood samples obtained, the number and type of radiological examinations, the number of specialist referrals and examinations, the type and number of all interventions carried out during ER stay.
RESULTS: The mean cost for patient was 516.50±405.80 and the mean length of stay in ER was 12.6±15.2 hours. A well-defined linear relationship between the length of stay and the cost of care was observed (R2 0.62, P<0.001). The conditions of respiratory failure and sepsis despite amounting to 30% of the observed cases, has produced a 40% of costs. It appears to be the reverse for cardiovascular conditions.
CONCLUSIONS: The length of stay and the patient condition are the most important determinants affecting the costs. When precise pathways of managements are defined (see cardiovascular patients) the patient’s length of stay in the resus room is shorter. Our results support the creation of protocols for rapid admission to areas where these patients can be admitted and treated at acceptable costs.

KEY WORDS: Clinical governance; Costs and cost analysis; Emergency service, hospital; Health care costs; Acute disease; Emergencies