Question

Middletown General Hospital ER Observation Unit 1. Questions: What was the average census of observation patients in the hospital? b. Using the 2011 patient flows, how large should the ED observation unit be to achieve a а. target utilization of 80% What was the profit flow in $/day from patients who entered the hospital (on either observation or admitted status) through the ED? d. Assume that an observation unit of your recommended size is built and the hospital experiences the exact same demand rate. Also assume that all of the inpatient beds that were formerly occupied by ER Observation patients can now be filled by inpatients (at the same LOS and profit/patient rate). Ignoring the fixed and variable costs to build the observation unit, what would be the benefit in $/day to the hospital for having the observation unit relative to the status quo? C. How can you verify the above assumption that "all of the inpatient beds that were formerly occupied by ER Observation patients can now be filled by inpatients (at the same LOS and profit/patient rate)" e. Is there a financial business case to be made for building the ED Observation unit with the backfill assumption? f. Conduct a sensitivity analysis to assess how the decision to build or not would change if the backfill assumption was partially realized (i.e. if only a portion of the inpatient beds g. were occupied by other inpatients)

this is from the Middletown General Hospital Emergency Department Observation Unit Analysis Exercise

Answer 1

a. From the Middletown General Hospital Emergency Department Observation Unit Analysis, the average census of the observation patient in the hospital are 200

b. Using the 2011 patient flows the average patient coming to the emergency department is 200 out of the total bed capacity of the whole hospital is 400. From these 200 patients of each day, an average of 150 was discharged only 50 were stayed as for the observation and admission. That means the emergency department is achieving only 25%.

To make the emergency department observation unit to achieve a target utilization of 80%, 160 patient should be stayed overnight out of 200. They should have to increase the target for 55% to reach 80%.

c. The profit gained from the patient is calculated as :

From the admitted patients is $ 3500 per day and the length of stay is average of 5.8 days

From the observation, patients are $ 3300 per day and the length of stay is an average of 1.2 days

d. If assuming all the inpatient bed were formerly occupied by emergency observation patients can now be filled by inpatients with the same length of stay and the patient rate/profit rate. Out of the 200 patients, 50 who were stayed as an inpatient with an average length of stay is 5.8 days.

Thus we can calculate the benefit per day is $3500.

If suppose if the patient is staying for the 5.8 days, we can calculate it as 5.8 x $3500

= a total of $20,300 for 5.8 days of stay.

e. Previously out of the census of 200 patients who were coming to the emergency department, 150 were discharged and 50 stayed back overnight. Out of this 50 stayed patients, 20% or 10 numbers were occupied by the patients on observation and 80% or 40 numbers were occupied as inpatients or admitted patients.(total number of the patient is 10 observation patient + 40 admitted patient = 50).

Now we are assuming the inpatient beds are filled only by the inpatient with the same length of stay and profit/ patient rate, the total number of inpatient beds is verified as admitted patients only, that means a total number of 50 inpatients instead of 40.

f. Surely, there is a financial business case to be made for building the emergency department observation unit with the backfill assumption, because she said to the team that they have to assume that all the vacated beds will be backfilled by the patients admitted as inpatients, then only can represent the profit as $3500 per day with an observation unit makes the economic sense.

g. The backfill assumption is not at all totally possible, instead of that a portion of the inpatient beds was allowed to occupied by the observation patients.