RESUMO
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 1â month in each follow-up year. RESULTS: The annual number of outpatient emergency contacts increased from n=10â 440 (2007; baseline) to n=16â 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 16â 326 patients in 2011 showed cost reductions of 417â 600 (27â 200 to 493â 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.