title: Operational and financial impact of physician screening in the ED.
abstract: BACKGROUND
  Physician screening is one of many front-end interventions being implemented to improve emergency department (ED) efficiency.
  
  
  OBJECTIVE
  We aimed to quantify the operational and financial impact of this intervention at an urban tertiary academic center.
  
  
  METHODS
  We conducted a 2-year before-after analysis of a physician screening system at an urban tertiary academic center with 90 000 annual visits. Financial impact consisted of the ED and inpatient revenue generated from the incremental capacity and the reduction in left without being seen (LWBS) rates. The ED and inpatient margin contribution as well as capital expenditure were based on available published data. We summarized the financial impact using net present value of future cash flows performing sensitivity analysis on the assumptions. Operational outcome measures were ED length of stay and percentage of LWBS.
  
  
  RESULTS
  During the first year, we estimate the contribution margin of the screening system to be $2.71 million and the incremental operational cost to be $1.86 million. Estimated capital expenditure for the system was $1 200 000. The NPV of this investment was $2.82 million, and time to break even from the initial investment was 13 months. Operationally, despite a 16.7% increase in patient volume and no decrease in boarding hours, there was a 7.4% decrease in ED length of stay and a reduction in LWBS from 3.3% to 1.8%.
  
  
  CONCLUSIONS
  In addition to improving operational measures, the implementation of a physician screening program in the ED allowed for an incremental increase in patient care capacity leading to an overall positive financial impact.
authors.affiliation: Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA. olanmd@gmail.com
authors.forename: Olanrewaju A
authors.initials: OA
authors.lastname: Soremekun
authors.forename: Paul D
authors.initials: PD
authors.lastname: Biddinger
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: White
authors.forename: Julia R
authors.initials: JR
authors.lastname: Sinclair
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Carignan
authors.forename: David F M
authors.initials: DF
authors.lastname: Brown
mesh_terms: D000046:Academic Medical Centers / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data; D000328:Adult; D003362:Cost-Benefit Analysis; D004469:Economics, Hospital / Q000706:statistics & numerical data; D017598:Efficiency, Organizational / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000458:organization & administration / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010820:Physicians