Implementation of a structured emergency nursing framework results in significant cost benefit

Curtis, K; Sivabalan, P; Bedford, DS; Considine, J; D’Amato, A; Shepherd, N; Fry, M; Munroe, B; Shaban, RZ

Implementation of a structured emergency nursing framework results in significant cost benefit

Curtis, K Sivabalan, P

Bedford, DS Considine, J D’Amato, A Shepherd, N Fry, M Munroe, B Shaban, RZ

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Publisher:: Springer Science and Business Media LLC
Publication Type:: Journal Article
Citation:: BMC Health Services Research, 2021, 21, (1)
Issue Date:: 2021-12

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Field	Value	Language
dc.contributor.author	Curtis, K
dc.contributor.author	Sivabalan, P https://orcid.org/0000-0002-7112-2385
dc.contributor.author	Bedford, DS
dc.contributor.author	Considine, J
dc.contributor.author	D’Amato, A
dc.contributor.author	Shepherd, N
dc.contributor.author	Fry, M
dc.contributor.author	Munroe, B
dc.contributor.author	Shaban, RZ
dc.date.accessioned	2021-12-12T23:16:22Z
dc.date.available	2021-12-12T23:16:22Z
dc.date.issued	2021-12
dc.identifier.citation	BMC Health Services Research, 2021, 21, (1)
dc.identifier.issn	1472-6963
dc.identifier.uri	http://hdl.handle.net/10453/152255
dc.description.abstract	<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>Patients are at risk of deterioration on discharge from an emergency department (ED) to a ward, particularly in the first 72 h. The implementation of a structured emergency nursing framework (HIRAID) in regional New South Wales (NSW), Australia, resulted in a 50% reduction of clinical deterioration related to emergency nursing care. To date the cost implications of this are unknown. The aim of this study was to determine any net financial benefits arising from the implementation of the HIRAID emergency nursing framework.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>This retrospective cohort study was conducted between March 2018 and February 2019 across two hospitals in regional NSW, Australia. Costs associated with the implementation of HIRAID at the study sites were calculated using an estimate of initial HIRAID implementation costs (AUD) ($492,917) and ongoing HIRAID implementation costs ($134,077). Equivalent savings per annum (i.e. in less patient deterioration) were calculated using projected estimates of ED admission and patient deterioration episodes via OLS regression with confidence intervals for incremental additional deterioration costs per episode used as the basis for scenario analysis.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>The HIRAID-equivalent savings per annum exceed the costs of implementation under all scenarios (Conservative, Expected and Optimistic). The estimated preliminary savings to the study sites per annum was $1,914,252 with a payback period of 75 days. Conservative projections estimated a net benefit of $1,813,760 per annum by 2022–23. The state-wide projected equivalent savings benefits of HIRAID equalled $227,585,008 per annum, by 2022–23.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The implementation of HIRAID reduced costs associated with resources consumed from patient deterioration episodes. The HIRAID-equivalent savings per annum to the hospital exceed the costs of implementation across a range of scenarios, and upscaling would result in significant patient and cost benefit.</jats:p> </jats:sec>
dc.language	en
dc.publisher	Springer Science and Business Media LLC
dc.relation.ispartof	BMC Health Services Research
dc.relation.isbasedon	10.1186/s12913-021-07326-y
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	0807 Library and Information Studies, 1110 Nursing, 1117 Public Health and Health Services
dc.subject.classification	Health Policy & Services
dc.title	Implementation of a structured emergency nursing framework results in significant cost benefit
dc.type	Journal Article
utslib.citation.volume	21
utslib.for	0807 Library and Information Studies
utslib.for	1110 Nursing
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney/Centre for Health Technologies (CHT)
utslib.copyright.status	open_access	*
dc.date.updated	2021-12-12T23:16:21Z
pubs.issue	1
pubs.publication-status	Published
pubs.volume	21
utslib.citation.issue	1

Abstract:

Abstract Background Patients are at risk of deterioration on discharge from an emergency department (ED) to a ward, particularly in the first 72 h. The implementation of a structured emergency nursing framework (HIRAID) in regional New South Wales (NSW), Australia, resulted in a 50% reduction of clinical deterioration related to emergency nursing care. To date the cost implications of this are unknown. The aim of this study was to determine any net financial benefits arising from the implementation of the HIRAID emergency nursing framework. Methods This retrospective cohort study was conducted between March 2018 and February 2019 across two hospitals in regional NSW, Australia. Costs associated with the implementation of HIRAID at the study sites were calculated using an estimate of initial HIRAID implementation costs (AUD) ($492,917) and ongoing HIRAID implementation costs ($134,077). Equivalent savings per annum (i.e. in less patient deterioration) were calculated using projected estimates of ED admission and patient deterioration episodes via OLS regression with confidence intervals for incremental additional deterioration costs per episode used as the basis for scenario analysis. Results The HIRAID-equivalent savings per annum exceed the costs of implementation under all scenarios (Conservative, Expected and Optimistic). The estimated preliminary savings to the study sites per annum was $1,914,252 with a payback period of 75 days. Conservative projections estimated a net benefit of $1,813,760 per annum by 2022–23. The state-wide projected equivalent savings benefits of HIRAID equalled $227,585,008 per annum, by 2022–23. Conclusions The implementation of HIRAID reduced costs associated with resources consumed from patient deterioration episodes. The HIRAID-equivalent savings per annum to the hospital exceed the costs of implementation across a range of scenarios, and upscaling would result in significant patient and cost benefit.

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