Preliminary outcomes and cost-benefit analysis of a community hospital emergency department screening and referral program for patients aged 75 or more

Purpose - The purpose of this article is to report preliminary outcome and cost-benefit results for a patient safety quality improvement program intended to improve outcomes for patients aged 75 or more visiting the Emergency Department (ED). The program uses the Identification of Seniors at Risk (ISAR) scale to screen, and refers patients at high risk for appropriate intervention. Design/methodology/approach - The Plan-Do-Study-Act improvement cycle was used as a framework. Simple outcomes have been assessed by comparing patient sub-groups based on risk status and interventions received. Cost and benefits were assessed based on estimated program outcomes and average costs. Sensitivity analysis was performed to test alternate assumptions. Findings - The screening tool appears to be accurate, and screening and referral appears to have a positive impact, reducing length of stay, returns to the ED, and subsequent admissions to hospital. However, most results are not statistically significant at the 95 percent level. The value of avoided care exceeds program costs under most assumptions. Originality/value - Screening and referring all eligible patients has still not been achieved; these are areas for future investigation and improvement. Screening and referral appear to be effective in improving outcomes but because program costs were low, net benefits may have been achieved; however given global budgeting for hospital care improvements in the use of resources (rather than budgetary savings) would be expected. The methods for improvement (the Plan-Do-Study-Act framework; process evaluation; multidisciplinary working group meetings; outcome assessment) are practical and useful for improving quality and safety in a small community hospital with limited resources.