OBJECTIVES: In Switzerland, emergency care has no gatekeeping system and emergency wards are increasingly overcrowded by walk-in patients. This leads to inefficient use of spezialised resources. Treatment costs are paid by public sources and, beyond some co-payment, reimbursed by health care insurances via tariffs. Given the problems above, a public hospital (Stadtspital Waid; Zurich; catchment population 180'000 people) reorganised its emergency service in 2008. A nurse led triage system and a General Practitioner-led emergency service was implemented beside the conventional emergency ward. To better understand the impact, we assessed quality of service provision and total treatment costs. METHODS: From the public payer perspective, we compared annual treatment costs for ambulatory emergency care in 2007 with 2009. In a pre-post study, all consecutive ambulatory emergency patients were included during one month in each year. Treatment costs (CHF) were calculated (e.g. nursing time multiplied with wages) and extrapolated to one year. Waiting times and patient satisfaction were used as indicators for service quality. Clinical outcome was not directly measured. RESULTS: The annual number of ambulatory patients increased from n=10'440 (2007) to n=16'035 (2009). Service provision improved with reduced waiting times (mean: 120 min vs. 60 min), persistently high patient satisfaction and more efficient resource use (additional diagnostic testing: 71% vs. 56%). Comparison of the annual local budget spent for treatment of 16,035 patients in 2009 (7,150,000 CHF; new service) with 2007 (7,184,000 CHF; old service, adjusted to 16,035 patients) showed slightly reduced costs (-34,000 CHF; 95%-CI:+60,000 to -127,000). CONCLUSIONS: The cost reduction of 0.5% is a conservative estimate as wages have increased since 2007. The reorganisation has the potential to be a dominant intervention: While quality of service provision improved, treatment costs slightly decreased against the secular trend of increase. Data has to be confirmed in follow-up measurements for decision makers.
Eichler, K., Senn, O., Rüthemann, I., Bögli, K., Sidler, P., & Brügger, U. (2011). PHP64 Reorganisation of Hospital Emergency Services: A Business Case for Quality Improvement. Value in Health, 14(7), A344–A345. https://doi.org/10.1016/j.jval.2011.08.615