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ON TOMORROW: @ConcertTcrc Cancer Roundtable featuring Prof Marie Ranson ( @mranson2 ) and Dr Tara Roberts ( @DrTaraLRoberts ) presenting on 'Drug Testing: Pros and Cons of cell culture and animal models'. Wed 12 August at 8am

How much impact does Postnatal Depression (PND) have on the conversation between a mother and her baby? And how does this conversation affect the child’s future development?

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The high cost of keeping patients in ED

For every additional hour that a patient spends waiting to be moved from the Emergency Department (ED) to a ward, there is a significant increased cost to the health system, a new study has found.

Professor Paul Middleton

The study, undertaken at Liverpool Hospital in Sydney’s South West by Professor Paul Middleton and his team, looks at the economic implications of lost bed capacity in an emergency department and is the first study of its kind in Australia.

Professor Middleton, who is the Director of the South Western Emergency Research Institute (SWERI), explains that when a decision for a patient to be admitted to the hospital has been made, but there is no inpatient bed to go to, it leads to a phenomenon known as “access block.” Access block has been associated with serious health outcomes, including both clinical errors and even increased mortality.

“When there are delays in getting a patient to the ward, not only is there a health risk to that patient who is missing out on timely treatment, but the opportunity to treat the next person with the urgency they may deserve is lost,” he explains.

Professor Middleton’s team devised the concept of lost bed capacity (LBC) to estimate the cost of staying in the ED beyond that required for actual emergency care.

Using patient ED data from the linked Comprehensive Emergency Dataset for Research Innovation and Collaboration (CEDRIC), the team set out to simulate what would happen when they removed lost bed capacity (LBC). Specifically, the study calculated the effects on Emergency Department length of stay and a health economic analysis to estimate the cost of the LBC.

“An emergency department is costly to run, and although little detailed data is available, it is probably the second most expensive place in a hospital after ICU. Patients occupying beds when they should ideally be in a less expensive environment incurs significant and unnecessary health system costs”

“Our study was an attempt to estimate how much LBC costs the hospital, which is basically money that could be better spent elsewhere in the system,” he explains.

The study found that LBC costs were an average of $202.99 per admitted patient per hour per bed.

With 2,909 ED patient admissions during the month of the study, it was estimated that cost of LBC to the ED was approximately $590,000.

“This is the real cost of patients occupying a bed in ED who shouldn’t be there,” says Prof. Middleton. “If we can work more efficiently as a whole system, with innovative real-time visualisation and control, we could end up with a lot more capacity.”

Professor Middleton and SWERI, funded by the SWSLHD, are currently using CEDRIC data and the LBC approach, in collaboration with computing experts from the UNSW School of Public Health and Community Medicine (SPHCM), to design sophisticated computer simulations demonstrating the way the components of the complex adaptive system, that is the ED and the hospital, can best be organised and made most effective and efficient.

This work promises to revolutionise the way our emergency systems work for critically ill and injured patients.

By Linda Music