I have been promoting self care, disease management and maintaining wellness at home and in the community as a principle strategy for reducing readmissions and containing healthcare costs. I dubbed this approach ‘heal in place.’
On the other end of the continuum is the ‘hold in place’ strategy often employed today. A FierceHealthcare critique of emergency rooms observes one study in the Annals of Emergency Medicine which demonstrates that “high emergency department crowding is associated with increased inpatient mortality, as well as moderate rises in length of stay and costs.”
The piece goes on to say that overcrowding is not so much the product of misuse of emergency resources as it is one of throughput stating “most crowding stems from ED boarding, in which emergency patients admitted to the hospital are waiting for an inpatient bed.” Allow me to add this caveat: overcrowding is only going to worsen as emergency rooms ‘hold in place’ not only patients waiting for a bed, but patients that they are attempting to not put in a bed through the use of “patient observation”; a strategy already on the rise to reduce admissions and contain readmissions.
In the cynical phrase of Aristotle Onassis; “After a certain point, money is meaningless. It ceases to be the goal. The game is what counts.”