To Batch or Not to Batch? Impact of Admission Batching on Emergency Department Boarding Time and Physician Productivity

• 成果类型: Article
• 署名作者: Feizi, Arshya; Carson, Anita; Jaeker, Jillian Berry; Baker, William Evan
• 署名单位: Harvard University; Boston University; University of Vermont; University of Vermont Medical Center
• 刊物名称: OPERATIONS RESEARCH
• ISSN/ISSBN: 0030-364X
• DOI: 10.1287/opre.2022.2335
• 发表日期: 2023
• 页码: 939-957
• 关键词: emergency department; batching; boarding; PRODUCTIVITY; healthcare operations; BEHAVIOR; empirical; queuing

摘要

We study the behavior of batching by discretionary workers in the first stage of a two-stage queuing system and explore the trade-off it causes between their productivity and second stage wait times. Specifically, we focus on the behavior of batching admissions by emergency department (ED) physicians. Using data from a large hospital, we show that the probability of batching admissions is increasing in the hour of an ED physician's shift, and that batched patients experience a 4.7% longer delay from hospital admission to receiving an inpatient bed. Using a mediation analysis, we show that this effect is partially due to the increase in the coefficient of variation of inpatient bed requests caused by batching. However, we also find that batching admissions is associated with an average of 10.0% more patients seen in a shift, and a 2.6 minute reduction in a physician's average throughput time. An important implication of our work is that workers may induce delays in downstream stages, caused by practices that increase their productivity.