• Sarah P Slight, Calvin Franz, Michael Olugbile, Harvey V Brown, David W Bates, and Eyal Zimlichman.
• 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.
• Crit. Care Med. 2014 Aug 1;42(8):1862-8.

ObjectivesTo 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.DesignReturn on investment analysis.SettingA 316-bed community hospital.PatientsMedicine, surgery, or trauma patients admitted or transferred to a 33-bed medical-surgical unit.InterventionsEach 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 ResultsTwo 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.ConclusionsImplementation 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.

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