Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Department of Emergency Medicine, HCA Houston Healthcare Northwest, Houston, Texas.
J Healthc Manag. 2024;69(3):219-230. doi: 10.1097/JHM-D-23-00150. Epub 2024 May 10.
Boarding emergency department (ED) patients is associated with reductions in quality of care, patient safety and experience, and ED operational efficiency. However, ED boarding is ultimately reflective of inefficiencies in hospital capacity management. The ability of a hospital to accommodate variability in patient flow presumably affects its financial performance, but this relationship is not well studied. We investigated the relationship between ED boarding and hospital financial performance measures. Our objective was to see if there was an association between key financial measures of business performance and limitations in patient progression efficiency, as evidenced by ED boarding.
Cross-sectional ED operational data were collected from the Emergency Department Benchmarking Alliance, a voluntarily self-reporting operational database that includes 54% of EDs in the United States. Freestanding EDs, pediatric EDs and EDs with missing boarding data were excluded. The key operational outcome variable was boarding time. We reviewed the financial information of these nonprofit institutions by accessing their Internal Revenue Service Form 990. We examined standard measures of financial performance, including return on equity, total margin, total asset turnover, and equity multiplier (EM). We studied these associations using quantile regressions of added ED volume, ED admission percentage, urban versus nonurban ED site location, trauma status, and percentage of the population receiving Medicare and Medicaid as covariates in the regression models.
Operational data were available for 892 EDs from 31 states. Of those, 127 reported a Form 990 in the year corresponding to the ED boarding measures. Median boarding time across EDs was 148 min (interquartile range [IQR]: 100-216). A significant relationship exists between boarding and the EM, along with a negative association with the hospital's total profit margin in the highest-performing hospitals (by profit margin percentage). After adjusting for the covariates in the regression model, we found that for every 10 min above 90 min of boarding, the mean EM for the top quartile increased from 245.8% to 249.5% (p < .001). In hospitals in the top 90th percentile of total margin, every 10 min beyond the median ED boarding interval led to a decrease in total margin of 0.24%.
Using the largest available national registry of ED operational data and concordant nonprofit financial reports, higher boarding among the highest-profitability hospitals (i.e., top 10%) is associated with a drag on profit margin, while hospitals with the highest boarding are associated with the highest leverage (i.e., indicated by the EM). These relationships suggest an association between a key ED indicator of hospital capacity management and overall institutional financial performance.
将患者收入急诊病房（ED）与降低医疗质量、患者安全和体验以及 ED 运营效率有关。然而，ED 收治最终反映了医院容量管理的效率低下。医院容纳患者流量变化的能力可能会影响其财务绩效，但这种关系尚未得到很好的研究。我们调查了 ED 收治与医院财务绩效衡量标准之间的关系。我们的目的是观察关键业务绩效衡量标准与 ED 收治之间是否存在关联，ED 收治是患者进展效率受限的证据。
从急诊基准联盟（Emergency Department Benchmarking Alliance）收集横断面 ED 运营数据，这是一个自愿报告运营数据库，包括美国 54%的 ED。排除了独立的 ED、儿科 ED 和缺少收治数据的 ED。关键运营结果变量是收治时间。我们通过访问非营利机构的内部收入服务表格 990 来审查这些机构的财务信息。我们检查了财务绩效的标准衡量标准，包括股本回报率、总利润率、总资产周转率和股权乘数（EM）。我们研究了这些关联，在回归模型中使用 ED 附加量、ED 入院率、城市与非城市 ED 位置、创伤状况以及接受医疗保险和医疗补助的人口百分比作为协变量进行分位数回归。
来自 31 个州的 892 个 ED 提供了运营数据。其中，127 个 ED 在 ED 收治措施对应的年份报告了表格 990。ED 收治中位数为 148 分钟（四分位距 [IQR]：100-216）。在表现最好的医院中，收治时间与 EM 之间存在显著关系，并且与医院的总利润率呈负相关。在回归模型中调整了协变量后，我们发现，每超过 90 分钟的收治时间增加 10 分钟，前四分之一分位数的平均 EM 从 245.8%增加到 249.5%（p<0.001）。在总利润率处于前 90%的医院中，每超过 ED 收治中位数 10 分钟，总利润率就会下降 0.24%。
使用最大的 ED 运营数据国家注册库和一致的非营利财务报告，最高利润医院（即前 10%）的收治率较高与利润率下降有关，而收治率最高的医院与最高杠杆率（即由 EM 表示）有关。这些关系表明，医院容量管理的关键 ED 指标与整体机构财务绩效之间存在关联。
