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Early Task Initiation and Other Load-Adaptive Mechanisms in the Emergency Department

Author

Listed:
  • Robert J. Batt

    (Wisconsin School of Business, University of Wisconsin–Madison, Madison, Wisconsin 53706)

  • Christian Terwiesch

    (The Wharton School and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104)

Abstract

We study a multistage service process that adapts to system occupancy level. Using operational data from more than 140,000 patient visits to a hospital emergency department, we show that the system-level performance of the emergency department is an aggregation of several simultaneous server-level workload response mechanisms. We identify early task initiation as a between-stage adaptive response mechanism that occurs when an upstream stage initiates tasks that are normally handled by a downstream stage. We show that having some diagnostic tests ordered during the triage process reduces treatment time by 20 minutes, on average. However, ordering too many tests at triage can lead to an increase in the total number of tests performed on the patient. We also demonstrate the presence of other response mechanisms such as queuing delays for tasks such as medication delivery, and rushing as nurses spend less time with their patients when the queue length is high.

Suggested Citation

  • Robert J. Batt & Christian Terwiesch, 2017. "Early Task Initiation and Other Load-Adaptive Mechanisms in the Emergency Department," Management Science, INFORMS, vol. 63(11), pages 3531-3551, November.
    • Handle: RePEc:inm:ormnsc:v:63:y:2017:i:11:p:3531-3551
    DOI: 10.1287/mnsc.2016.2516
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    References listed on IDEAS

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    1. Tom Fangyun Tan & Serguei Netessine, 2014. "When Does the Devil Make Work? An Empirical Study of the Impact of Workload on Worker Productivity," Management Science, INFORMS, vol. 60(6), pages 1574-1593, June.
    2. Wallace J. Hopp & Seyed M. R. Iravani & Gigi Y. Yuen, 2007. "Operations Systems with Discretionary Task Completion," Management Science, INFORMS, vol. 53(1), pages 61-77, January.
    3. Van de Ven, Wynand P. M. M. & Van Praag, Bernard M. S., 1981. "The demand for deductibles in private health insurance : A probit model with sample selection," Journal of Econometrics, Elsevier, vol. 17(2), pages 229-252, November.
    4. David C. Chan, 2016. "Teamwork and Moral Hazard: Evidence from the Emergency Department," Journal of Political Economy, University of Chicago Press, vol. 124(3), pages 734-770.
    5. Hummy Song & Anita L. Tucker & Karen L. Murrell, 2015. "The Diseconomies of Queue Pooling: An Empirical Investigation of Emergency Department Length of Stay," Management Science, INFORMS, vol. 61(12), pages 3032-3053, December.
    6. Kenneth L. Schultz & David C. Juran & John W. Boudreau & John O. McClain & L. Joseph Thomas, 1998. "Modeling and Worker Motivation in JIT Production Systems," Management Science, INFORMS, vol. 44(12-Part-1), pages 1595-1607, December.
    7. Askin, Ronald G. & Chen, Jiaqiong, 2006. "Dynamic task assignment for throughput maximization with worksharing," European Journal of Operational Research, Elsevier, vol. 168(3), pages 853-869, February.
    8. Saed Alizamir & Francis de Véricourt & Peng Sun, 2013. "Diagnostic Accuracy Under Congestion," Management Science, INFORMS, vol. 59(1), pages 157-171, December.
    9. Massimiliano Bratti & Alfonso Miranda, 2011. "Endogenous treatment effects for count data models with endogenous participation or sample selection," Health Economics, John Wiley & Sons, Ltd., vol. 20(9), pages 1090-1109, September.
    10. Genji Yamazaki & Hirotaka Sakasegawa, 1987. "An Optimal Design Problem for Limited Processor Sharing Systems," Management Science, INFORMS, vol. 33(8), pages 1010-1019, August.
    11. Richard C. Larson, 1987. "OR Forum—Perspectives on Queues: Social Justice and the Psychology of Queueing," Operations Research, INFORMS, vol. 35(6), pages 895-905, December.
    12. Bradley R. Staats & Francesca Gino, 2012. "Specialization and Variety in Repetitive Tasks: Evidence from a Japanese Bank," Management Science, INFORMS, vol. 58(6), pages 1141-1159, June.
    13. Jo Thori Lind & Halvor Mehlum, 2010. "With or Without U? The Appropriate Test for a U‐Shaped Relationship," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 72(1), pages 109-118, February.
    14. Michael Freeman & Nicos Savva & Stefan Scholtes, 2017. "Gatekeepers at Work: An Empirical Analysis of a Maternity Unit," Management Science, INFORMS, vol. 63(10), pages 3147-3167, October.
    15. Jennifer M. George & J. Michael Harrison, 2001. "Dynamic Control of a Queue with Adjustable Service Rate," Operations Research, INFORMS, vol. 49(5), pages 720-731, October.
    16. Ludwig Kuntz & Roman Mennicken & Stefan Scholtes, 2015. "Stress on the Ward: Evidence of Safety Tipping Points in Hospitals," Management Science, INFORMS, vol. 61(4), pages 754-771, April.
    17. Jillian A. Berry Jaeker & Anita L. Tucker, 2017. "Past the Point of Speeding Up: The Negative Effects of Workload Saturation on Efficiency and Patient Severity," Management Science, INFORMS, vol. 63(4), pages 1042-1062, April.
    18. Rogelio Oliva & John D. Sterman, 2001. "Cutting Corners and Working Overtime: Quality Erosion in the Service Industry," Management Science, INFORMS, vol. 47(7), pages 894-914, July.
    19. Diwas Singh KC & Christian Terwiesch, 2012. "An Econometric Analysis of Patient Flows in the Cardiac Intensive Care Unit," Manufacturing & Service Operations Management, INFORMS, vol. 14(1), pages 50-65, January.
    20. Diwas S. Kc & Christian Terwiesch, 2009. "Impact of Workload on Service Time and Patient Safety: An Econometric Analysis of Hospital Operations," Management Science, INFORMS, vol. 55(9), pages 1486-1498, September.
    21. Thomas B. Crabill, 1972. "Optimal Control of a Service Facility with Variable Exponential Service Times and Constant Arrival Rate," Management Science, INFORMS, vol. 18(9), pages 560-566, May.
    22. Michael Anderson & Carlos Dobkin & Tal Gross, 2012. "The Effect of Health Insurance Coverage on the Use of Medical Services," American Economic Journal: Economic Policy, American Economic Association, vol. 4(1), pages 1-27, February.
    23. Durbin, J, 1970. "Testing for Serial Correlation in Least-Squares Regression When Some of the Regressors are Lagged Dependent Variables," Econometrica, Econometric Society, vol. 38(3), pages 410-421, May.
    24. Robert J. Batt & Christian Terwiesch, 2015. "Waiting Patiently: An Empirical Study of Queue Abandonment in an Emergency Department," Management Science, INFORMS, vol. 61(1), pages 39-59, January.
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