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Study: Hospitalists Improve ED Throughput


Hospitalist-led, active-bed management can save hospitals millions of dollars a year by reducing ambulance diversions and trimming emergency department (ED) throughput times, according to a single-institution study.

The study in Annals of Internal Medicine (2008;149(11):804-810) found twice-daily bed management rounds in the ICU and regular visits to the ED to assess flow reduced ED throughput by 98 minutes. It also cut the number of ambulance diversions for overcrowding by 6% and reduced diversions caused by a lack of ICU beds by 27%. The study compared data from November 2005 to February 2006 (control period) and November 2006 to February 2007 (intervention period).

Lead author Eric Howell, MD, a hospitalist with Collaborative Inpatient Medical Service at Johns Hopkins Bayview Medical Center in Baltimore, estimated ambulance diversions cost hospitals $1,000 to $8,000 an hour. His study found a decrease of more than 2,000 hours in ambulance diversions, which could translate into $16 million in annual savings

"You've got to have the money up front," Dr. Howell says, acknowledging startup costs for a new or expanded hospitalist program. "You can't do it on the cheap. It falls apart."

Smaller hospitalist groups without the staffing for a full-time program could run a 12-hour, daytime version, or a trial run during specific hours.

"It's not an easy thing to do," he says, "but it adds tremendous value to a hospitalist group."

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