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The effects of unexpected changes in demand on the performance of emergency departments

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  • Alex J. Turner
  • Laura Anselmi
  • Yiu‐Shing Lau
  • Matt Sutton

Abstract

Crowding in emergency departments (EDs) is increasing in many health systems. Previous studies of the relationship between crowding and care quality are limited by the use of data from single hospitals, a focus on particular patient groups, a focus on a narrow set of quality measures, and use of crowding measures which induce bias from unobserved hospital and patient characteristics. Using data from 139 hospitals covering all major EDss in England, we measure crowding using quasi‐exogenous variation in the volume of EDs attendances and examine its impacts on indicators of performance across the entire EDs care pathway. We exploit variations from expected volume estimated using high‐dimensional fixed effects capturing hospital‐specific variation in attendances by combinations of month and hour‐of‐the‐week. Unexpected increases in attendance volume result in substantially longer waiting times, lower quantity and complexity of care, more patients choosing to leave without treatment, changes in referral and discharge decisions, but only small increases in reattendances and no increase in mortality. Causal bounds under potential omitted variable bias are narrow and exclude zero for the majority of outcomes. Results suggest that physician and patient responses may largely mitigate the impacts of demand increases on patient outcomes in the short‐run.

Suggested Citation

  • Alex J. Turner & Laura Anselmi & Yiu‐Shing Lau & Matt Sutton, 2020. "The effects of unexpected changes in demand on the performance of emergency departments," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1744-1763, December.
  • Handle: RePEc:wly:hlthec:v:29:y:2020:i:12:p:1744-1763
    DOI: 10.1002/hec.4167
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    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 7th December 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-12-07 12:00:03

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    Cited by:

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    2. Walsh, Brendan & Brick, Aoife, 2023. "Inpatient bed capacity requirements in Ireland in 2023: Evidence on the public acute hospital system," Research Notes RN20230101, Economic and Social Research Institute (ESRI).
    3. McQuinn, Kieran & O'Toole, Conor & Disch, Wendy & Shiel, Eva & Kenny, Eoin, 2023. "Quarterly Economic Commentary, Spring 2023," Forecasting Report, Economic and Social Research Institute (ESRI), number QEC2023SPR, August.
    4. 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).
    5. Dormont, Brigitte & Dottin, Alexis, 2024. "Does the opening of an emergency department influence hospital admissions? Evidence from French private hospitals," Social Science & Medicine, Elsevier, vol. 340(C).

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