There is a line item no hospital budget carries, and it is one of the largest in the building: the compounding cost of preventable patient delays. Delayed discharges, extended ED holds, cancelled procedures, beds that can't be filled because the turnover chain is broken. Aggregated across the U.S. acute care system, it runs into the billions every year. I put it at $3.6 billion, and I think that's conservative.
Transport is not the only cause. But it is the central one, for a structural reason: transport is the engine that interfaces with every other engine. It picks up patients from nursing, depends on clean beds prepared by EVS, and has to operate in rhythm with linen to keep the whole system from stalling. When transport drifts, the delay doesn't stay in transport. It multiplies downstream. A 15-minute transport delay during the afternoon discharge surge becomes a 45-minute bed availability gap by 4 p.m. That gap hits ED boarding, surgical throughput, and patient experience simultaneously.
The money is not theoretical. For a 400-bed hospital with $200 million in annual Medicare revenue, Value-Based Purchasing puts up to 2% of DRG revenue at risk. That's $4 million of exposure, and every 0.1% of VBP performance is worth roughly $200,000 a year. Transport performance is one of the quiet variables that decides where that 2% lands.
Here is the number that should stop you: almost none of the workforce running this engine holds a professional credential. We built the CHT pathway because the answer to the $3.6 billion problem is not more transporters. It is transport teams that are credentialed, accountable, and operationally aligned with the hospital's throughput goals.
You cannot fix a system by adding bodies to it. You fix it by professionalizing the people who run it.