title: The financial burden of emergency department congestion and hospital crowding for chest pain patients awaiting admission.
abstract: OBJECTIVE
  We determined the additional cost of an extended emergency department (ED) length of stay for chest pain patients awaiting non-ICU, monitored (telemetry) beds.
  
  
  METHODS
  This was a prospective cohort study of all ED chest pain patients aged 24 years or older and admitted to a telemetry bed in an urban university hospital during a 12-month period. Structured ED data collection included demographics, chest pain presentation, medical history, and laboratory test and ECG results. Hospital course was monitored daily, followed by a 30-day telephone follow-up. Risk severity scores (Goldman, Acute Cardiac Ischemia-Time-Insensitive Predictive Instrument, and Charlson) were calculated. Hospital charges, real costs, and revenues were obtained at discharge and 2 years later. The main outcome measure was risk-adjusted additional cost to the hospital of a delayed ED admission. Clinical outcome was a secondary measure.
  
  
  RESULTS
  Of the 817 patients with chest pain presenting to the ED during the study period, there were 904 hospitalizations. Of these, 825 patients waited more than 3 hours for their bed (91%). There were 21 patient visits with a final diagnosis of acute myocardial infarction. ED length of stay was not associated with total hospital length of stay (r =0.01), hospital costs, or hospital or professional charges, revenues, or collection rates. The annual opportunity cost in lost hospital revenue for chest pain patients was 168,300 US dollars (204 US dollars per patient waiting >3 hours for a hospital bed).
  
  
  CONCLUSIONS
  Extended ED length of stay demonstrated no association with total hospital costs or revenues or total hospital length of stay but imposed substantial ED opportunity costs, with decreased potential revenue. Interventions that reduce ED delays in hospital admissions have the potential to significantly increase hospital revenues.
authors.affiliation: Department of Medicine, School of Medicine, The Wharton School.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Bayley
authors.forename: J Sanford
authors.initials: JS
authors.lastname: Schwartz
authors.forename: Frances S
authors.initials: FS
authors.lastname: Shofer
authors.forename: Mark
authors.initials: M
authors.lastname: Weiner
authors.forename: Frank D
authors.initials: FD
authors.lastname: Sites
authors.forename: K Bobbi
authors.initials: KB
authors.lastname: Traber
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000191:economics* / Q000628:therapy; D003441:Crowding; D004636:Emergency Service, Hospital / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006301:Health Services Needs and Demand; D006742:Hospital Bed Capacity / Q000191:economics*; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000191:economics*; D010414:Pennsylvania; D011446:Prospective Studies; D013997:Time Factors