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Abstract
Problem definition: This work aims to examine the role of emergency department (ED) operational status related to congestion in fast-track (FT) routing decisions and the subsequent effects on patient outcomes. Methodology/results: In this paper, we utilize a two-year data set from two hospital EDs in Alberta, Canada, and adopt an instrumental variable approach to examine the effects of FT routing decisions on patient outcomes. Based on the empirical findings, we utilize a data-calibrated simulation to compare the performance of different routing policies. First, our study reveals that FT routing decisions are not purely clinically driven, and ED operational status is also associated with FT routing decisions. Second, being routed to FT can improve ED efficiency by reducing the average length of stay and left without being seen rates. However, this efficiency improvement comes at the cost of potential quality decline. In particular, being routed to the FT leads to an 8.2% increase in the 48-hour revisit rate for the high-complexity group and a 2.3% increase for the medium-complexity group. Third, we delve into the mechanisms behind observed patient outcomes and find that physicians in the FT area may prioritize expediting patient flow by simplifying patient diagnosis and treatment procedures. Consequently, the quality of care may be compromised for high- and medium-complexity patients. Finally, our simulation findings highlight the importance of selecting the "right"patients to be routed to the FT unit. To this end, the complexity-based classification method and dynamic routing policies emerge as promising avenues. Managerial implications: Our findings call for immediate attention from healthcare practitioners to carefully balance the trade-off between emergency care efficiency and quality, emphasizing the necessity of selecting the right patients for routing. Copyright: © 2024 INFORMS.
Original language | English |
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Pages (from-to) | 75-93 |
Journal | Manufacturing and Service Operations Management |
Volume | 27 |
Issue number | 1 |
Online published | 6 Nov 2024 |
DOIs | |
Publication status | Published - Jan 2025 |
Funding
This study is partially supported by the Hong Kong Research Grants Council [Grants GRF11508921 and CRF C7162-20G
Research Keywords
- behavioral operations
- emergency department
- empirical healthcare
- fast-track routing
- simulation
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Dive into the research topics of 'Emergency Care Efficiency vs. Quality: Uncovering Hidden Consequences of Fast-Track Routing Decisions'. Together they form a unique fingerprint.Projects
- 1 Active
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GRF: Investigation of Fast-Track Routing Decisions and Its Impact in Hospital Emergency Departments
SUN, Z. (Principal Investigator / Project Coordinator) & XU, Y. (Co-Investigator)
1/01/22 → …
Project: Research