Resuscitation Care Units improve efficiency, documentation and reimbursement costs for hospitals

Resuscitation Care Units (RCUs) provide intensive, comprehensive and immediate medical care for critically ill patients with life-threatening conditions, such as cardiac arrest, requiring specialized monitoring and rapid intervention from a multidisciplinary team. Many studies have shown that creating these special high-acuity areas in an emergency department, can save lives and improve patient outcomes. However, questions about financial sustainability have slowed adoption of these units.

A new study by researchers at Boston University Chobanian & Avedisian School of Medicine and UMass Chan Medical School has found these dedicated units not only benefitted patients, but resulted in improved efficiency, documentation and reimbursement costs for the hospital.

"For patients, RCUs mean that the sickest people in the emergency department receive faster, more focused care from specially trained teams. For the health system, it means this approach can pay for itself, because the billing better matches the real work being done; which makes it more likely that hospitals will be willing to adopt these units, which in turn can improve emergency care for everyone," explains corresponding author Michael Sherman, MD, MA, FACEP, assistant professor of emergency medicine & critical care medicine at the school.

The researchers performed a retrospective review of approximately 75,000 emergency visits at

UMass Memorial Medical Center, a busy urban hospital. They compared the 35 weeks before and after the institution opened a nine-bed RCU in July 2019. They reviewed the billing codes (which reflect the intensity of care) and revenue from those visits and then compared the patterns with a nearby hospital in the same system that didn't have an RCU. This novel study showed a strong association with RCU's and improved ED efficiency and coding, representing more accurate reimbursement for these units and demonstrating the fiscal sustainability of the model.

According to the researchers, RCU's are known to decrease the need for ICU admission, shorten hospital and intensive care unit stays and cut direct costs by preventing illness from worsening. "By centralizing care for the sickest patients, RCUs help doctors and nurses deliver antibiotics, fluids and other lifesaving treatments faster, while freeing ICU beds for patients who need longer-term care," adds Sherman who also is an emergency & critical care physician at Boston Medical Center.

Beyond money and coding, the study suggests that changing how emergency departments are organized can improve care and efficiency. "It shows that small changes in workflow (like staffing ratios and dedicated space) can have a big impact without building a whole new department or building," says Sherman.

These finding appear online in the Western Journal of Emergency Medicine.