D030 Task 2 Service Line Finances and KPIs Example

Nursing Service Line Proposal, Part Two: Finances, Cost-Benefit, Risks, and Key Performance Indicators for a Regional Sexual Assault Nurse Examiner Service

Student Name

Leavitt School of Health, Western Governors University

D030: Leadership and Management in Complex Healthcare Systems, Task 2

Course Instructor

Month Day, Year

Nursing Service Line Proposal, Part Two: Finances, Cost-Benefit, Risks, and Key Performance Indicators for a Regional Sexual Assault Nurse Examiner Service

Executive Summary

This proposal asks leadership to approve a SANE (sexual assault nurse examiner) service, run by nurses on a regional basis, covering the health system's referral hospital and its three rural critical access hospitals. The service would provide 24-hour forensic nursing care in person at the hub and by guided video at the rural sites, so that no survivor has to be transferred or drive an hour for an examination. The market analysis identified 118 patients reporting sexual assault across the four emergency departments last year, with 32 of the 41 rural patients either transferred or leaving without an examination. The SWOT analysis found strong internal assets, including existing examiners, shared records and video equipment, alongside rural staffing limits and recruitment risks. The service would cost about $272,000 in its first year and about $217,000 a year after that, and would be funded by examination reimbursement, victim services grants and a modest contribution from the system's community benefit budget. The key performance indicators below would show within the first year whether it is working.

Financial Overview

All figures are illustrative estimates for a composite system and would be refined with the finance department.

Revenue Projections

Forensic examinations are reimbursed through the state's program for sexual assault examinations, which pays a fixed amount per examination so that survivors are not billed. Using an illustrative state rate of $900 per complete examination and projected volumes of 125 examinations in year one and 150 in year two, as more survivors seek care locally, examination revenue would be about $112,500 in year one and $135,000 in year two. Related emergency services, such as laboratory tests and medications billed to insurance, are not counted here because the emergency departments already receive that revenue. The system would apply for federal and state victim services grants for examiner training and equipment, estimated at $120,000 a year for the first two years, and would commit $40,000 a year from its community benefit budget, which nonprofit hospitals must spend on community health needs.

Budget Allocation and Operational Costs

The largest cost is people. A 0.8 full-time equivalent program coordinator costs about $92,000 including benefits. On-call pay for one examiner at all times, at an illustrative $6 per hour across 8,760 hours, costs $52,560, and callback pay for examinations, averaging four hours at $58 per hour for 125 cases, costs about $29,000. Training eight new examiners through a 40-hour course and supervised clinical practice costs about $36,000 in year one and $8,000 a year afterward for continuing education. Equipment, including forensic cameras, alternate light sources and secure evidence storage at the four sites, costs about $32,000 in year one, with the existing tele-stroke carts reused for video consultation. Supplies, evidence kits not supplied by the state, medications and court-time pay add about $30,000 a year, and a share of the victim advocate's time is funded by the partner crisis center. Year-one costs are therefore about $272,000, against projected revenue and funding of about $272,500. From year two, with training and equipment largely paid for and 150 examinations, ongoing costs fall to about $217,000, against about $295,000 in revenue and funding while grants last.

Cost-Benefit Analysis

On direct costs alone, the service roughly breaks even in its first years, provided the grant funding is secured, and becomes more dependent on examination volume and community benefit funds after grants end. The measurable savings come mostly from avoided transfers. Last year 23 rural patients were transferred for examination; at an illustrative $1,400 per ground ambulance transfer and the nurse time lost from a small emergency department, local examinations would save about $32,000 a year, much of it to payers and the public.

The larger benefits are harder to price but central to the case. Survivors would receive emergency contraception and infection prophylaxis sooner and closer to home, and fewer would leave without care. Forensic documentation would be more complete, which the literature associates with better support for prosecution and with more coordinated community response (Campbell et al., 2005). For the health system, the service meets a need identified in its community health needs assessment, strengthens relationships with law enforcement and advocates, and reduces the risk that a poorly handled case harms the rural hospitals' standing in their communities. Weighed together, the benefits justify a cost that is modest by the standards of a regional health system.

Risk Assessment

Four risks stand out. Examiner burnout and vicarious trauma could drive turnover; the coordinator will limit on-call shifts to six per month per examiner, hold a debrief after every case and arrange confidential counseling through the employee assistance program. Evidence handling errors could compromise cases; standardized kits, chain-of-custody forms in the electronic record and quarterly audits with the state crime lab will reduce this risk. Video consultation raises privacy concerns, even though most patients offered a remote examiner in one program accepted (Miyamoto et al., 2025); sessions will use the system's encrypted platform, will not be recorded and will begin only after the patient consents to the remote examiner. Finally, loss of grant funding after two years could leave a gap; the coordinator will report outcomes to the board annually and pursue permanent budget support from the second year, before grants end.

Key Performance Indicators

The indicators follow the structure, process and outcome model set out by Donabedian (1988). The structure indicator is the proportion of hours each month with a certified or trained examiner available to all four sites, in person or by video, with a target of 100% by month six. The process indicator is the proportion of patients who report sexual assault and choose an examination who have it started within 60 minutes of arrival, measured from the electronic record, with a target of 85%. The outcome indicator is the proportion of examined patients who receive all medications indicated by protocol, including emergency contraception when appropriate and infection prophylaxis, before discharge, with a target of 95%. A supporting measure will track the number of patients who leave without an examination, with the aim of reducing it to zero.

Conclusion

A regional SANE service is affordable for a health system of this size, can be launched with existing examiners and equipment, and addresses a clear gap in rural care. With funding secured for the first two years, risks managed through staff support and evidence protocols, and progress tracked through structure, process and outcome indicators, the service line offers leadership a measurable way to improve care for some of the most vulnerable patients who come through its doors.

References

Campbell, R., Patterson, D., & Lichty, L. F. (2005). The effectiveness of sexual assault nurse examiner (SANE) programs: A review of psychological, medical, legal, and community outcomes. Trauma, Violence, & Abuse, 6(4), 313-329. https://doi.org/10.1177/1524838005280328

Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 260(12), 1743-1748. https://doi.org/10.1001/jama.1988.03410120089033

Miyamoto, S., Delwiche, J., Mareboina, M., Hur, Y. S., & Greninger, E. (2025). Acceptability of forensic sexual assault telehealth consultation. Telemedicine and e-Health, 31(4), 424-430. https://doi.org/10.1089/tmj.2024.0461