A Time-driven, Activity-based Costing Analysis of Alternative ED Transport Options Treatment-in-Place and Transport to Alternative Destination
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Abstract
Background: Reducing acute care utilization (i.e., Emergency Department (ED) visits and hospitalizations) is critical to reducing total costs of care. Offering alternatives to ED transport for many lower acuity Emergency Medical Services (EMS) calls is a promising pathway toward reducing acute care use. We used a Time-Driven Activity-Based Costing (TDABC) method to analyze the costs of implementing two Alternative Care Pathways (ACPs) for EMS treatment that seek to reduce ED transport: treatment-in-place and transport to an alternative destination in a midwestern ambulance service.
Methods: Publicly available costs per unit of time were determined for needed equipment and personnel resources, including a fully staffed and equipped ambulance, an emergency physician, an ED nurse, and an emergency dispatcher. Process maps were developed to estimate resource times for four treatment outcomes: usual care (transport to the ED), treat-in-place, transport to an alternative destination, and an unsuccessful ACP attempt with transport to the ED. Costs were estimated for each treatment outcome.
Results: The least expensive pathway was treat-in-place, costing $1,559 per intervention, followed by transport to an alternative destination ($2,151), and usual care ($3,677). Thus, each successful completion of treat-in-place could offset the costs associated with 6.5 attempted but failed ACP interventions (that culminated in ED transport). Each successful transport to an alternative destination offset 4.7 attempted but unsuccessful ACP interventions.
Conclusions: ACP implementation can result in substantial cost savings, though results will need to be validated in other settings.
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