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The Return on Investment of Implementing a Continuous Monitoring System in General Medical-Surgical Units*

Slight, Sarah P. MPharm, PhD PGDip1,2; Franz, Calvin PhD3; Olugbile, Michael MBBS, MPH1; Brown, Harvey V. MD4; Bates, David W. MD, MSc1,5; Zimlichman, Eyal MD, MSc1,6

doi: 10.1097/CCM.0000000000000340
Clinical Investigations

Objectives: To evaluate the cost savings attributable to the implementation of a continuous monitoring system in a medical-surgical unit and to determine the return on investment associated with its implementation.

Design: Return on investment analysis.

Setting: A 316-bed community hospital.

Patients: Medicine, surgery, or trauma patients admitted or transferred to a 33-bed medical-surgical unit.

Interventions: Each bed was equipped with a monitoring unit, with data collected and compared in a 9-month preimplementation period to a 9-month postimplementation period.

Measurements and Main Results: Two models were constructed: a base case model (A) in which we estimated the total cost savings of intervention effects and a conservative model (B) in which we only included the direct variable cost component for the final day of length of stay and treatment of pressure ulcers. In the 5-year return on investment model, the monitoring system saved between $3,268,000 (conservative model B) and $9,089,000 (base model A), given an 80% prospective reimbursement rate. A net benefit of between $2,687,000 ($658,000 annualized) and $8,508,000 ($2,085,000 annualized) was reported, with the hospital breaking even on the investment after 0.5 and 0.75 of a year, respectively. The average net benefit of implementing the system ranged from $224 per patient (model B) to $710 per patient (model A) per year. A multiway sensitivity analyses was performed using the most and least favorable conditions for all variables. In the case of the most favorable conditions, the analysis yielded a net benefit of $3,823,000 (model B) and $10,599,000 (model A), and for the least favorable conditions, a net benefit of $715,000 (model B) and $3,386,000 (model A). The return on investment for the sensitivity analysis ranged from 127.1% (25.4% annualized) (model B) to 601.7% (120.3% annualized) (model A) for the least favorable conditions and from 627.5% (125.5% annualized) (model B) to 1739.7% (347.9% annualized) (model A) for the most favorable conditions.

Conclusions: Implementation of this monitoring system was associated with a highly positive return on investment. The magnitude and timing of these expected gains to the investment costs may justify the accelerated adoption of this system across remaining inpatient non-ICU wards of the community hospital.

1The Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA.

2School of Medicine, Pharmacy and Health, The University of Durham, Durham, United Kingdom.

3Eastern Research Group, Inc., Lexington, MA.

4California Hospital Medical Center and David Geffen School of Medicine, UCLA, Los Angeles, CA.

5Harvard Medical School, Boston, MA.

6The Chaim Sheba Medical Center, Tel Hashomer, Israel.

* See also p. 1952.

This work was performed at Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA.

Supported, in part, by an industry grant provided by EarlySense.

Dr. Franz’s institution consulted for Division of General Internal Medicine, Brigham and Women’s Hospital and received grant support from the National Institutes of Health-Harvard Pilgrim Healthcare and AHRQ-DGIM, BWH. Dr. Brown consulted for and received travel support from EarlySense. Dr. Bates consulted for Earlysense. His institution received grant support from Earlysense. Dr. Zimlichman’s institution received grant support and support for travel from Earlysense. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins