title: Sustained health-economic effects after reorganisation of a Swiss hospital emergency centre: a cost comparison study.
abstract: BACKGROUND
  Emergency departments (EDs) are increasingly overcrowded by walk-in patients. However, little is known about health-economic consequences resulting from long waiting times and inefficient use of specialised resources. We have evaluated a quality improvement project of a Swiss urban hospital: In 2009, a triage system and a hospital-associated primary care unit with General Practitioners (H-GP-unit) were implemented beside the conventional hospital ED. This resulted in improved medical service provision with reduced process times and more efficient diagnostic testing. We now report on health-economic effects.
  
  
  METHODS
  From the hospital perspective, we performed a cost comparison study analysing treatment costs in the old emergency model (ED, only) versus treatment costs in the new emergency model (triage plus ED plus H-GP-unit) from 2007 to 2011. Hospital cost accounting data were applied. All consecutive outpatient emergency contacts were included for 1 month in each follow-up year.
  
  
  RESULTS
  The annual number of outpatient emergency contacts increased from n=10 440 (2007; baseline) to n=16 326 (2011; after intervention), reflecting a general trend. In 2007, mean treatment costs per outpatient were €358 (95% CI 342 to 375). Until 2011, costs increased in the ED (€423 (396 to 454)), but considerably decreased in the H-GP-unit (€235 (221 to 250)). Compared with 2007, the annual local budget spent for treatment of 16 326 patients in 2011 showed cost reductions of €417 600 (27 200 to 493 600) after adjustment for increasing patient numbers.
  
  
  CONCLUSIONS
  From the health-economic point of view, our new service model shows 'dominance' over the old model: While quality of service provision improved (reduced waiting times; more efficient resource use in the H-GP-unit), treatment costs sustainably decreased against the secular trend of increase.
authors.affiliation: Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.
authors.forename: Klaus
authors.initials: K
authors.lastname: Eichler
authors.affiliation: Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.
authors.forename: Sascha
authors.initials: S
authors.lastname: Hess
authors.affiliation: City Hospital Waid, Zurich, Switzerland Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland.
authors.forename: Corinne
authors.initials: C
authors.lastname: Chmiel
authors.affiliation: City Hospital Waid, Zurich, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Bögli
authors.affiliation: City Hospital Waid, Zurich, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sidler
authors.affiliation: Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Senn
authors.affiliation: Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.affiliation: Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Brügger
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration; D017598:Efficiency, Organizational / Q000592:standards; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration*; D005194:Family Practice / Q000191:economics / Q000458:organization & administration; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013557:Switzerland; D014218:Triage / Q000191:economics / Q000458:organization & administration; D014850:Waiting Lists; D055815:Young Adult
keywords: emergency department; management, cost efficiency; management, emergency department management; primary care