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Overview
Overview
LWBS
ALOS
Overtime
Summary
Overview
These calculators are intended to demonstrate how improving the performance of various KPIs within emergency department operations, or areas directly affected by those operations, can impact an organization's financial position. The cells shaded yellow can be changed to reflect the circumstances of a specific situation. Typical default values have been provided, but values that are realistic for a particular organization will provide more meaningful insights. Cells shaded green reflect the results of the calculations.
Instructions
Fill in the orange-shaded boxes with values that reflect your organization's current performance levels and future targets.
Key
Editable Cell
Intermediate Calculation
Opportunity Calculation Result
Abbreviations
ED
Emergency Department
HPPV
(Nursing staff) hours per ED patient visit
IP
Inpatient admissions (from the ED)
LWBS
Left without being seen
OP
Outpatient visits
OT
Overtime
Oppty $
Value of improvement opportunity in dollars
T&R
Treat & release ED patient departures
Calculator
: LWBS (left with being seen) Improvement
Premise
: When emergency departments are overcrowded, wait times increase and in extreme cases hospitals go on diversion. In both instances patients will go elsewhere for their healthcare when possible. The impact is both an immediately quantifiable loss of opportunity as well as damage to reputation which can discourage future patient loyalty. Reducing LWBS rates can recapture lost revenue immediately as well as increase longer term prospects from increased loyalty.
Opportunity
: Decrease the LWBS rate by improving workflow efficiencies, operational processes, and interdepartmental coordination.
Annual ED Visit Volume
LWBS %
LWBS Departures
% Admissions
Lost Admits
Oppty $ / IP
IP $ Lost
% T&R Departs
Lost T&R Departs
Oppty $ / OP
OP $ Lost
Current Scenario
Future Scenario
Value of Improvement
Current Lost Opportunity
Future Lost Opportunity
Value of Gain
Calculator
: Average Length of Stay (ALOS) Reduction
Premise
: Hospital workflow is impacted significantly by how quickly patients can be appropriately discharged from inpatient units.
The emergency department plays a integral role in a hospital's overall patient flow. Patients boarded in the ED have been shown to have longer lengths of stay. Also, optimizing hospital discharge processes frees up capacity for patients to be admitted to inpatient units sooner. Among the benefits of optimizing patient flow is the incremental value of an increased
number of elective inpatient procedures which require beds for pre and post-operative care during peak occupancy periods. This value can be estimated by computing the number of additional elective hospital visits that would be possible by improving patient flow and multiplying that by the value (based on DRG payments) of typical elective procedures.
Opportunity
: Improve ALOS from current level to one that reflects efficient discharge processes that still ensure the appropriate standard of care.
Staffed Bed Capacity
% Capacity Avg
Occupancy Avg
Days/Year
Bed Days/Year
ALOS
Inpatients Visits/Year
Current Scenario
Future Scenario
Value of Improvement
Gain in # of Potential Inpatient Visits
Percent of Capacity Gain Used for Elective Procedures
Additional Elective Procedures
Value of Typical Inpatient Elective Procedure*
Additional Value of Capacity Gain
* Examples of Common Medicare MS-DRG Facility Payments for Elective Surgical Procedures (2020)
Hospital Base Rate:
% of Discharges
DRG Weight
DRG Payment
MS-DRG
470-MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC
247-PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC
469-MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC OR TOTAL ANKLE REPLACEMENT
467-REVISION OF HIP OR KNEE REPLACEMENT W CC
462-BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC
enter additional DRG information if appropriate
Typical Elective Procedure Value
Calculator
: Overtime Premium Pay Reduction & Staff Efficiency Improvement
Premise
: The combination of efficient emergency department processes and more precise staff planning holds the potential to reduce overtime and other premium pay. Understanding various patterns in emergency department volumes provides
opportunities to create more accurate staff forecasts and avoid last minute staffing changes that may come with expensive premium compensation.
Scenario
: Reduce the percentage of emergency department nursing staff hours with overtime pay & increase staff efficiency.
Annual ED Visit Volume
Nursing HPPV*
Required Staff Hrs
OT Hrs %
OT
$s / Hr
Value of OT
Current Scenario
Future Scenario
Value of Improvement
Cost of Current Overtime Expenses
Cost of Future Overtime Expenses
Cost Savings from Reducing Overtime
Note
: Estimates of nursing staff efficiency (HPPV) can also be changed in conjunction with altering overtime hours percentage.
* HPPV: nursing hours per patient emergency department patient visit
** Reference:
Using Predictive Analytics to Align ED Staffing Resources with Patient Demand
, Skinner, et al, hfma, January 2018
Summary of Potential Annual Financial Benefits Possible through Improvements in Hospital Workflow Efficiency including Emergency Department Operations
Improving Left Without Being Seen Rate:
Reducing Inpatient Average Length of Stay:
Mimimizing Staff Overtime:
Total: