Evaluation of the Costs and Consequences of Implementing an Optimization Process for Low-Complexity Emergency Care: The LINEA Program

<b>Introduction:</b> Overcrowding is persistent in emergency departments (EDs) worldwide and can result in adverse patient outcomes and prolonged lengths of stay. Delays in care and unmet demand contribute to negative outcomes for patients awaiting treatment, including increased morbidity and mortality, prolonged hospital stays, and overall lower quality of medical care. Overcrowding in EDs not only diminishes patient satisfaction with the entire hospitalization experience, beyond the ED, but also significantly increases healthcare costs and contributes to a rise in medical errors. Therefore, developing strategies that optimize the limited resources available for emergency patient care, especially for those with low-complexity emergencies, is crucial. <b>Objective:</b> To evaluate whether implementing a specific care strategy for patients with low-complexity emergencies can effectively reduce costs and improve clinical outcomes and patient-reported experiences compared with standard care practices. <b>Methods:</b> A cost-consequence model was employed to separately evaluate the costs and outcomes of each alternative. The cost and outcome analyses were applied to healthcare services using the database of a tertiary-level ED, analyzed from the perspective of the healthcare service provider over a 2-year time horizon. To assess the perspective of the healthcare provider institution, the cost-consequence analysis was conducted using a decision tree model. <b>Results:</b> The study included 43 268 patients. No significant differences were found in demographic variables between groups. A significant difference was found in total length of stay in minutes between groups: minimum (median interquartile range [IQR]), 534 (456-644) vs 494 (364-719) (<i>P</i> < .001). In addition, there was an improvement in the NPS value from 44 to 53 throughout the ED, with 0.005% mortality in the study group and 0.07 in the control group (<i>P</i> < .001). Finally, a significant difference was documented in the mean billing per patient, with a median (IQR) of Col <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mn>255</mml:mn> <mml:mrow><mml:mo> </mml:mo></mml:mrow> <mml:mn>903</mml:mn> <mml:mo>(</mml:mo> <mml:mi>C</mml:mi> <mml:mi>o</mml:mi> <mml:mi>l</mml:mi></mml:math> 151 108-Col <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mn>658</mml:mn> <mml:mrow><mml:mo> </mml:mo></mml:mrow> <mml:mn>585</mml:mn> <mml:mo>)</mml:mo> <mml:mi>v</mml:mi> <mml:mi>s</mml:mi> <mml:mi>t</mml:mi> <mml:mi>h</mml:mi> <mml:mi>e</mml:mi> <mml:mi>c</mml:mi> <mml:mi>o</mml:mi> <mml:mi>m</mml:mi> <mml:mi>p</mml:mi> <mml:mi>a</mml:mi> <mml:mi>r</mml:mi> <mml:mi>i</mml:mi> <mml:mi>s</mml:mi> <mml:mi>o</mml:mi> <mml:mi>n</mml:mi> <mml:mi>g</mml:mi> <mml:mi>r</mml:mi> <mml:mi>o</mml:mi> <mml:mi>u</mml:mi> <mml:mi>p</mml:mi> <mml:mi>a</mml:mi> <mml:mi>n</mml:mi> <mml:mi>d</mml:mi> <mml:mi>C</mml:mi> <mml:mi>o</mml:mi> <mml:mi>l</mml:mi></mml:math> 283 922 (Col <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mn>125</mml:mn> <mml:mrow><mml:mo> </mml:mo></mml:mrow> <mml:mn>998</mml:mn> <mml:mo>-</mml:mo> <mml:mi>C</mml:mi> <mml:mi>o</mml:mi> <mml:mi>l</mml:mi></mml:math> 776 097) (<i>P</i> < .018). <b>Conclusion:</b> The implementation of a specialized unit for the care of patients with low-complexity emergencies within the ED has proven effective in improving total patient length of stay. This significantly contributes to reducing overcrowding, decreasing mortality, and reducing unmet demand. As a result, there is an overall improvement in user satisfaction within the ED.