A Novel Approach to Identifying Targets for Cost Reduction in the Emergency Department

Ann Emerg Med. 2013 Mar;61(3):293-300. doi: 10.1016/j.annemergmed.2012.05.042. Epub 2012 Jul 13.


This article introduces a novel framework that classifies emergency department (ED) visits according to broad categories of severity, identifying those categories of visits that present the most potential for reducing costs associated with the ED. Although cost savings directly attributable to the ED are apt to be an important emphasis of organizations operating under reformed payment systems, our framework suggests that a focus on diverting low-acuity visits away from the ED would result in far less savings compared with strategies aimed at reducing admissions and to a lesser extent improving the efficiency of ED care for intermediate or complex conditions. We conclude that targeting these categories, rather than minor injuries/illnesses, should be the primary focus of cost-reduction strategies from the ED. Given this understanding, we then discuss the implications of these findings on the financing of an emergency care system that needs to account for the required fixed costs of "stand-by capacity" of the ED and explore ways in which the ED can be better integrated into a patient-centered health care system.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost Savings / economics
  • Cost Savings / methods*
  • Delivery of Health Care, Integrated / economics
  • Delivery of Health Care, Integrated / organization & administration
  • Emergency Service, Hospital / economics*
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / statistics & numerical data
  • Health Care Reform / economics
  • Health Care Reform / organization & administration
  • Health Care Reform / statistics & numerical data
  • Health Policy / economics
  • Hospital Costs / statistics & numerical data
  • Humans
  • Severity of Illness Index
  • Trauma Severity Indices
  • United States