Boarding admitted patients in emergency departments (EDs) is a national crisis that is worsening despite potential financial disadvantages. The objective of this study was to assess costs associated with boarding. We conducted a prospective, observational investigation of patients admitted through an ED for management of acute stroke at a large, urban, academic, comprehensive stroke center hospital. We employed time-driven activity-based costing methodology to estimate cost for patient care activities during admission and aggregated results to estimate the total cost of boarding versus inpatient care. Primary outcomes were total daily costs per patient for medical-surgical (med/surg) boarding, med/surg inpatient care, ICU boarding, and ICU inpatient care. The total daily cost per patient with acute stroke was US$1856, for med/surg boarding versus US$993 for med/surg inpatient care and US$2267, for ICU boarding versus US$2165, for ICU inpatient care. These differences were even greater when accounting for costs associated with traveler nurses. ED nurses spent 293 min/d (mean) caring for each med/surg boarder; inpatient nurses spent 313 min/d for each med/surg inpatient. ED nurses spent 419 min/d caring for each ICU boarder; inpatient nurses spent 787 min/d for each ICU inpatient. Neurology attendings and residents spent 25 and 52 min/d caring for each med/surg boarder versus 62 minutes and 90 minutes for each med/surg inpatient, respectively. Using advanced cost-accounting methods, our investigation provides novel evidence that boarding of admitted patients is financially costly, adding greater urgency for elimination of this practice.

中文翻译：

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使用时间驱动的基于活动的成本法测量急诊科的寄宿成本


急诊室（ED）收治的患者寄宿是一场全国性危机，尽管存在潜在的经济困难，但这场危机仍在不断恶化。本研究的目的是评估与寄宿相关的费用。我们对一家大型城市学术综合性卒中中心医院通过急诊科收治急性卒中的患者进行了前瞻性观察性调查。我们采用时间驱动的基于活动的成本计算方法来估计入院期间患者护理活动的成本，并汇总结果来估计寄宿与住院护理的总成本。主要结局是每名患者的内科手术（内科/外科）寄宿、内科/外科住院护理、ICU 寄宿和 ICU 住院护理的每日总费用。每名急性卒中患者的每日总费用（内科/外科寄宿）为 1856 美元，而内科/外科住院护理为 993 美元；ICU 寄宿为 2267 美元，而 ICU 住院护理为 2165 美元。当考虑到与旅行护士相关的成本时，这些差异甚至更大。急诊室护士每天花费 293 分钟（平均）照顾每位内科/外科寄宿生；住院护士每天为每位内科/外科住院患者花费 313 分钟。急诊科护士每天花费 419 分钟照顾每位 ICU 寄宿人员；住院护士每天为每个 ICU 住院患者花费 787 分钟。神经科主治医师和住院医师每天花费 25 分钟和 52 分钟照顾每位内科/外科寄宿生，而每位内科/外科住院患者每天分别花费 62 分钟和 90 分钟。使用先进的成本会计方法，我们的调查提供了新的证据，表明住院患者的寄宿在经济上成本高昂，增加了消除这种做法的紧迫性。