Investigation of Patient Prioritization Behaviors in Hospital Emergency Departments

Project: Research

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Upon arrival at emergency departments (EDs), patients are classified into different triage levels indicating their urgency. Using data from an urban hospital in Canada, we find that within the same triage level, the average waiting time (time from triage to physician initial assessment) of discharge patients is shorter than that of admit patients for middle-to-low acuity patients, suggesting that the order of patients being served deviates from FCFS (first-come-first-served), and to certain extent, discharge patients are prioritized over admit patients. This observation is intriguing as among patients of the same triage level, admit patients - who need further care in the hospital - should be deemed no less urgent than discharge patients who only need treatment at EDs. To understand the prioritization behaviors of ED decision makers (nurses and physicians) in choosing the next patient for treatment, we carried out a preliminary study using a discrete choice model to develop our hypotheses. Based on the preliminary results, we conjecture that decision makers apply urgency-specific delay-dependent prioritization. Moreover, such prioritization behaviors also depend on the system congestion level, especially the ED blocking level -- the percentage of beds occupied by boarding patients. We conjecture that (i) when ED blocking level is sufficiently low, admit patients are prioritized over discharge patients for high acuity patients, and the first-come-first-served rule is followed for middle-to-low acuity patients; (ii) otherwise, the risk of ED being blocked becomes sufficiently high, decision makers start to prioritize patients who are less likely to be admitted after treatment at the ED. Our hypotheses imply that the prioritization decisions at EDs are not purely clinical driven but also takes capacity rationing into account. While there have been behavioral studies on medical decision making, the patient prioritization behavior at EDs, i.e., which patient to treat next, has not been investigated. This proposed study aims to shed light on this problem.Our objective is to test our hypotheses through sophisticated econometric models and investigate the impact of the patient prioritization decisions on ED operational performances. Physicians and nurses are central to the daily ED operations. By testing and highlighting their patient prioritization behaviors, this paper will advance our understanding of ED operations and patient flow. In this proposal, we present our preliminary results and describe a set of tasks for achieving our goals. Our team's training and research experiences in emergency medicine and operations management have prepared us to carry out the proposed research. 


Project number9043066
Grant typeGRF
Effective start/end date1/01/21 → …