Hospitals May Profit from Small Reductions in ER Boarding Time

April 20, 2011 - Washington, DC - A one-hour reduction in the average emergency department boarding time could result in millions of additional dollars per year in revenue for hospitals that implement active bed management strategies.  The results of a financial analysis and simulation model using real hospital data were reported online yesterday in Annals of Emergency Medicine ("The Financial Consequences of Lost Demand and Reducing Boarding in Hospital Emergency Departments").

"This study helps debunk the conventional wisdom that boarding patients in the ER maximizes hospital profits," said lead study author Jesse M. Pines, MD, FACEP of George Washington University in Washington D.C.  "Boarding is a major problem across the United States that results in poor patient care and worse outcomes. What we found is that it is possible for smart hospital managers to make more money and provide better ER service through less boarding if they are willing to cancel an occasional scheduled admission."

Researchers created models to determine what combination of emergency department admissions and scheduled admissions leads to highest hospital revenues.  They determined that when hospital occupancy reached a certain point, a reduction of scheduled admissions of only 5 percent (generally only a few patients) would lead to an increase in hospital revenue of $7,418 per day.  

"From a medical standpoint, less boarding is better for patients," said Dr. Pines.  "Patients who need treatment are seen faster and patients who have been admitted to the hospital get out of the hallway faster. Just one hour less of boarding could trigger a cascade of positive events - better health for our patients and better profits for the hospital."

Because emergency department admissions typically generate significantly less hospital revenue than scheduled admissions, hospital administrators have tended to favor scheduled admissions over emergency department admissions when allocating inpatient beds.  Hard limits on beds allocated to emergency department admissions have led to patients being held in the emergency department for hours, the practice known as boarding.  This study attempted to develop an admissions management policy that could be used during periods of peak emergency admissions to maximize hospital revenue.

"The optimal strategies we tested resulted in at least $2.7 million more a year for the hospital," said co-author Robert J. Batt, MBA, of The Wharton School at the University of Pennsylvania in Philadelphia.  "A small adjustment in scheduled admissions now and then could have a big impact on both patient health and the hospital's bottom line."

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit


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