Time-Driven Activity-Based Costing of Emergency Department Postdischarge Nurse Calls

EXECUTIVE SUMMARY Postdischarge telephone calls by nurses can decrease patient return rates to healthcare systems. To date, call program costs have not been compared with patient return rates to determine cost-effectiveness. We used time-driven activity-based costing to determine the costs associated with such programs. We developed process maps for a postdischarge nurse call program in the emergency department of an urban, quaternary care, academic, Level 1 trauma center. Our primary outcome was the total cost of calls, which is based on the length of the calls (after 8 hours of observation) and the total capacity rate cost based on national registered nurse salary and space costs. Seven-day return rate differences between patients reached and those not reached from July 2018 to March 2019 were determined with a Z-test. We observed 113 postdischarge calls for 79 patients. The mean (SD) length of calls for patients reached was 4.3 minutes (1.8) compared with 2.6 minutes (0.6) for those not reached. The total capacity rate cost for calls was $1.09/minute, or $4.69 per patient reached and $2.83 per patient not reached. A retrospective analysis of 6,698 patients reached and 6,519 patients not reached showed hospital return rates of 3.5% and 6.3% (p < .0001), respectively. The study findings show that postdischarge calls were associated with decreased return rates to the emergency department and a savings of $134.89 per prevention of one return. In deciding whether to use postdischarge call programs, healthcare systems should also consider the effects on specific demographics and the potential benefits of greater patient satisfaction and increased treatment adherence.