Cost-effectiveness of a physician-nurse supplementary triage assessment team at an academic tertiary care emergency department.
OBJECTIVE
The purpose of this study was to evaluate the cost-effectiveness of physician-nurse supplementary triage assistance team (MDRNSTAT) from a hospital and patient perspective.


METHODS
This was a cost-effectiveness evaluation of a cluster randomized control trial comparing the MDRNSTAT with nurse-only triage in the emergency department (ED) between the hours of 0800 and 1500. Cost was MDRNSTAT salary. Revenue was from Ontario's Pay-for-Results and patient volume-case mix payment programs. The incremental cost-effectiveness ratio was based on MDRNSTAT cost and three consequence assessments: 1) per additional patient-seen; 2) per physician initial assessment (PIA) hour saved; and 3) per ED length of stay (EDLOS) hour saved. Patient opportunity cost was determined. Patient satisfaction was quantified by a cost-benefit ratio. A sensitivity analysis extrapolating MDRNSTAT to different working hours, salary, and willingness-to-pay data was performed.


RESULTS
The added cost of the MDRNSTAT was $3,597.27 [$1,729.47 to ∞] per additional patient-seen, $75.37 [$67.99 to $105.30] per PIA hour saved, and $112.99 [$74.68 to $251.43] per EDLOS hour saved. From the hospital perspective, the cost-benefit ratio was 38.6 [19.0 to ∞] and net present value of -$447,996 [-$435,646 to -$459,900]. For patients, the cost-benefit ratio for satisfaction was 2.8 [2.3 to 4.6]. If MDRNSTAT performance were consistently implemented from noon to midnight, it would be more cost-effective.


CONCLUSIONS
The MDRNSTAT is not a cost-effective daytime strategy but appears to be more feasible during time periods with higher patient volume, such as late morning to evening.
*Department of Clinical Science and Education,Sodersjukhuset-Karolinska Institutet,Stockholm,Sweden.
Ivy
I
Cheng
*Department of Clinical Science and Education,Sodersjukhuset-Karolinska Institutet,Stockholm,Sweden.
Maaret
M
Castren
‡Institute of Clinical Evaluative Sciences,Sunnybrook Health Sciences Centre,Toronto,ON.
Alex
A
Kiss
¶Department of Family Medicine,Schulich School of Medicine and Dentistry,Western University,London,ON.
Merrick
M
Zwarenstein
‖Department of Learning, Informatics, Management, and Ethics,Solna-Karolinska Institutet,Stockholm,Sweden.
Mats
M
Brommels
§HOPE Research Centre,Sunnybrook Health Sciences Centre,Toronto,ON.
Nicole
N
Mittmann
D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics*; D006801:Humans; D009726:Nurses; D010348:Patient Care Team; D010820:Physicians; D063128:Tertiary Health Care; D014218:Triage / Q000191:economics*
Cost Effective Analysis; Emergency Department Administration; Emergency Department Crowding; Physician Triage; Senior Doctor Triage; System Evaluation