CIHI Survey: ED spending in Canada: a focus on the cost of patients waiting for access to an in-patient bed in Ontario.

2005–2006, hospitals in Canada spent $1.8 billion on their emergency departments (EDs). In the same year, more than one million patients were admitted via EDs. (This rate excludes hospitalizations in Quebec and hospitalizations for woman admitted for childbirth and infants born in hospital.) Based on analyses included in the Canadian Institute for Health Information (CIHI) Understanding Emergency Wait Times: Access to Inpatient Beds and Patient Flow (2007), we know that the majority of emergency patients admitted to hospital via an ED wait in the ED for access to an in-patient bed. Half the patients in our study waited for at least two hours, and one quarter of admitted patients waited more than 24 hours to be moved from the ED to an acute care bed. In this article, we have explored the proportion of ED spending that is dedicated to patients waiting for a bed. We have found that 6.5% of ED spending in Ontario (or $51 million) was dedicated to these patients in Ontario. It is generally agreed that there have been few studies of the costs of ED services (Bamezai et al. 2005; Williams 1996). Studies that have looked at ED costs for admitted patients compared with those discharged home have found higher costs associated with admitted patients, particularly those who are older and those who visit large EDs located in urban areas (Bennett et al. 2007; Higginson and Guly 2007). The intent of this article is to describe a method that can be used to determine the proportion of hospital spending and an estimated dollar value of spending in the ED that is associated with admitted patients waiting for access to an in-patient bed. Estimates at the provincial and Local Health Integration Network (LHIN) levels are provided. The method is based on financial and nursing workload reporting; it does not take into consideration issues external to the hospital that could impact costs such as availability of family physicians near the ED. Additional questions that need to be considered to more fully examine and understand ED costs are proposed in our conclusion.