BACKGROUND: Emergency department (ED) utilization by non-emergent patients poses challenges to care access and resource allocation. Notably, postoperative patients represent 10% of these visits. Previous research revealed that 84.5% of patients were managed with medications or reassurance, highlighting the benefit of redirecting patients before they present to the ED.
METHODS: We conducted a retrospective chart review on pediatric urology patients at a free-standing tertiary care children’s hospital who presented to the ED within 30 days of surgery from November 2019 to November 2022. Data was collected on primary ED complaint, urology procedure, charges, and duration of ED visit. A pediatric urologist assessed the relevance and urgency of each visit.
RESULTS: Penile complications comprised only 44.8% (39/82) of all urology-related ED presentations, but constituted 74.46% (35/47) of non-emergent cases, those manageable in an office setting outside the ED. Of these penile complications, 35 out of 39 were non-emergent, representing the highest proportion of primary urology-related complaints in this cohort, as shown in Table 1. Scrotal complications accounted for the second-largest portion of primary urology-related complaints, with 5 out of 11 cases being non-emergent. All 10 Urinary tract infection (UTI) cases were emergent. Less common primary complaints included urinary retention, hydronephrosis, nausea/vomiting, suprapubic tube-related concerns, urine leak, wound infection, and renal calculus.
Time and cost data for different patient segments were collected. These segments, analyzed in increasing granularity, consistently revealed low reimbursement and lengthy wait times. The three populations of interest were urology-related patients (n=82), non-emergent urology-related patients (n=47), and non-emergent penile complications (n=35).
Notably, the total charge for all non-emergent urology-related patients was $18,305, and for non-emergent penile complications, it was $12,580. Reimbursements were $5,624 and $3,843, respectively. The combined time spent for all non-emergent urology-related patients was 111.31 hours, and for non-emergent penile complaints, it was 73.38 hours. From the patient's perspective, the average non-emergent urology patient spent an average of 2.37 hours in the ED. The average non-emergent patient with penile complications spent 2.03 hours in the ED.
CONCLUSIONS:
Our assessment of a single surgical service, pediatric urology, demonstrated that post-operative returns are often non-emergent, poorly reimbursed, and excessively time-consuming.
This free-standing tertiary care children’s hospital spent an aggregated 111.31 hours on non-emergent urology-related cases. This represents many wasted dollars on upkeep and staffing for patients who could have been handled in the clinic setting. The hospital was only reimbursed 30.7% ($5,624/$18,305) on these non-emergent patients, resulting in a $12,681 net loss.
Our findings present an opportunity for hospital systems and patients to benefit from opening an after-hours clinic capable of managing penile complications. For patients, such a clinic may result in a reduction in wait time and charge for non-emergent post-operative patients. For the hospital system, such a clinic could result in a reduction in ED burden and the impact of poorly-reimbursed ED visits on the hospital system.
