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Triage at shift changes and distortions in the perception and treatment of emergency patients

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  • Ferro, Simone
  • Serra, Chiara

Abstract

Employing more than 2 million emergency department (ED) records, we combine machine learning and regression discontinuity to document novel distortions in triage nurses’ assessments of patients’ conditions and investigate the short- and medium-term consequences for patients. We show that triage nurses progressively become more lenient during their shifts, and identical ED patients arriving just after a shift change are thus assigned a lower priority. We show that these patients receive lower levels of care and require additional emergency care afterward. We conclude that distortions in nurses’ initial assessments of urgency bias’ medical staff’s perceptions.

Suggested Citation

  • Ferro, Simone & Serra, Chiara, 2025. "Triage at shift changes and distortions in the perception and treatment of emergency patients," Journal of Health Economics, Elsevier, vol. 99(C).
    • Handle: RePEc:eee:jhecon:v:99:y:2025:i:c:s0167629624000894
    DOI: 10.1016/j.jhealeco.2024.102944
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    1. Hirshleifer, David & Levi, Yaron & Lourie, Ben & Teoh, Siew Hong, 2019. "Decision fatigue and heuristic analyst forecasts," Journal of Financial Economics, Elsevier, vol. 133(1), pages 83-98.
    2. Alan I. Barreca & Melanie Guldi & Jason M. Lindo & Glen R. Waddell, 2011. "Saving Babies? Revisiting the effect of very low birth weight classification," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 126(4), pages 2117-2123.
    3. Sebastian Calonico & Matias D Cattaneo & Max H Farrell, 2020. "Optimal bandwidth choice for robust bias-corrected inference in regression discontinuity designs," The Econometrics Journal, Royal Economic Society, vol. 23(2), pages 192-210.
    4. David C. Chan & Jonathan Gruber, 2020. "Provider Discretion and Variation in Resource Allocation: The Case of Triage Decisions," AEA Papers and Proceedings, American Economic Association, vol. 110, pages 279-283, May.
    5. Maria R. Ibanez & Michael W. Toffel, 2020. "How Scheduling Can Bias Quality Assessment: Evidence from Food-Safety Inspections," Management Science, INFORMS, vol. 66(6), pages 2396-2416, June.
    6. Jonathan Levav & Mark Heitmann & Andreas Herrmann & Sheena S. Iyengar, 2010. "Order in Product Customization Decisions: Evidence from Field Experiments," Journal of Political Economy, University of Chicago Press, vol. 118(2), pages 274-299, April.
    7. Lindsey Woodworth & James F. Holmes, 2020. "Just A Minute: The Effect Of Emergency Department Wait Time On The Cost Of Care," Economic Inquiry, Western Economic Association International, vol. 58(2), pages 698-716, April.
    8. Robert J. Batt & Diwas S. KC & Bradley R. Staats & Brian W. Patterson, 2019. "The Effects of Discrete Work Shifts on a Nonterminating Service System," Production and Operations Management, Production and Operations Management Society, vol. 28(6), pages 1528-1544, June.
    9. David C. Chan, 2018. "The Efficiency of Slacking off: Evidence From the Emergency Department," Econometrica, Econometric Society, vol. 86(3), pages 997-1030, May.
    10. Tanguy Brachet & Guy David & Andrea M. Drechsler, 2012. "The Effect of Shift Structure on Performance," American Economic Journal: Applied Economics, American Economic Association, vol. 4(2), pages 219-246, April.
    11. Elena Cottini & Claudio Lucifora & Gilberto Turati & Daria Vigani, 2020. "Children Use of Emergency Care: Differences Between Natives and Migrants in Italy," DISCE - Working Papers del Dipartimento di Economia e Finanza def093, Università Cattolica del Sacro Cuore, Dipartimenti e Istituti di Scienze Economiche (DISCE).
    12. Emil Persson & Kinga Barrafrem & Andreas Meunier & Gustav Tinghög, 2019. "The effect of decision fatigue on surgeons' clinical decision making," Health Economics, John Wiley & Sons, Ltd., vol. 28(10), pages 1194-1203, October.
    13. Turner, Alex J & Francetic, Igor & Watkinson, Ruth & Gillibrand, Stephanie & Sutton, Matt, 2022. "Socioeconomic inequality in access to timely and appropriate care in emergency departments," Journal of Health Economics, Elsevier, vol. 85(C).
    14. Matias D. Cattaneo & Michael Jansson & Xinwei Ma, 2018. "Manipulation testing based on density discontinuity," Stata Journal, StataCorp LLC, vol. 18(1), pages 234-261, March.
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    More about this item

    Keywords

    Triage; Emergency care; Shift change;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • M50 - Business Administration and Business Economics; Marketing; Accounting; Personnel Economics - - Personnel Economics - - - General

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