Emergency Care Efficiency vs. Quality: Uncovering Hidden Consequences of Fast-Track Routing Decisions

• 成果类型: Article
• 署名作者: Hao, Shuai; Sun, Zhankun; Xu, Yuqian
• 署名单位: Southern University of Science & Technology; City University of Hong Kong; University of North Carolina; University of North Carolina Chapel Hill; University of North Carolina School of Medicine
• 刊物名称: M&SOM-MANUFACTURING & SERVICE OPERATIONS MANAGEMENT
• ISSN/ISSBN: 1523-4614
• DOI: 10.1287/msom.2022.0440
• 发表日期: 2025
• 关键词: emergency department; empirical healthcare; behavioral operations; fast-track routing; simulation

摘要

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.