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Publication type: Article in scientific journal
Type of review: Peer review (publication)
Title: Sustained health-economic effects after reorganisation of a Swiss hospital emergency centre : a cost comparison study
Authors: Eichler, Klaus
Hess, Sascha
Chmiel, Corinne
Bögli, Karin
Sidler, Patrick
Senn, Oliver
Rosemann, Thomas
Brügger, Urs
DOI: 10.21256/zhaw-4885
Published in: Emergency Medicine Journal
Volume(Issue): 31
Issue: 10
Page(s): 818
Pages to: 823
Issue Date: 2014
Publisher / Ed. Institution: BMJ Publishing Group
ISSN: 1472-0205
Language: English
Subject (DDC): 362.11: Hospitals and related institutions
Abstract: Background: Emergency departments (EDs) are increasingly overcrowded by walk-in patients. However, little is known about health-economic consequences resulting from long waiting times and inefficient use of specialised resources. We have evaluated a quality improvement project of a Swiss urban hospital: In 2009, a triage system and a hospital-associated primary care unit with General Practitioners (H-GP-unit) were implemented beside the conventional hospital ED. This resulted in improved medical service provision with reduced process times and more efficient diagnostic testing. We now report on health-economic effects. Methods: From the hospital perspective, we performed a cost comparison study analysing treatment costs in the old emergency model (ED, only) versus treatment costs in the new emergency model (triage plus ED plus H-GP-unit) from 2007 to 2011. Hospital cost accounting data were applied. All consecutive outpatient emergency contacts were included for 1 month in each follow-up year. Results The annual number of outpatient emergency contacts increased from n=10 440 (2007; baseline) to n=16 326 (2011; after intervention), reflecting a general trend. In 2007, mean treatment costs per outpatient were €358 (95% CI 342 to 375). Until 2011, costs increased in the ED (€423 (396 to 454)), but considerably decreased in the H-GP-unit (€235 (221 to 250)). Compared with 2007, the annual local budget spent for treatment of 16 326 patients in 2011 showed cost reductions of €417 600 (27 200 to 493 600) after adjustment for increasing patient numbers. Conclusions: From the health-economic point of view, our new service model shows ‘dominance’ over the old model: While quality of service provision improved (reduced waiting times; more efficient resource use in the H-GP-unit), treatment costs sustainably decreased against the secular trend of increase.
Fulltext version: Published version
License (according to publishing contract): CC BY-NC 3.0: Attribution - Non commercial 3.0 Unported
Departement: School of Management and Law
Organisational Unit: Winterthur Institute of Health Economics (WIG)
Appears in collections:Publikationen School of Management and Law

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