Patient Sensitivity to Emergency Department Waiting Time Announcements

Abstract

Problem definition: Emergency department (ED) delay announcement systems are implemented in many countries. We answer three important questions pertaining to the operations and effectiveness of such systems by studying the public hospital network and ED waiting time (WT) announcement system in Hong Kong SAR’s ‘universal’ public healthcare system: (1) How many patients are aware of (and sensitive to) the ED WT announcements? (2) How sensitive are these patients to the announced WT? (3) How can the Hong Kong government improve the WT announcement system? Methodology/results: We study over 1.3 million patient visits to the 17 tier one public EDs. We structurally estimate the fraction of patients sensitive to the announced WT and their sensitivity to the announcements as well as patient characteristics that lead to higher sensitivity. In the patient's ED choice decision, we estimate the tradeoff between the travel distance to an ED and the expected WT at the ED. We simulate the operation of the three EDs on Hong Kong Island for counterfactual policy study. We find that 2.5% of the patients are sensitive to the announced WT and they are willing to travel an additional 6.8 km to save one hour of waiting. Counterfactual analysis shows that the average WT and number of left without being seen patients can be reduced by 1.4% and 11.5%, respectively, by increasing the awareness (fraction of sensitive patients) to 15.8% and, simultaneously, reducing the announced WT update window to one hour from the current level of three hours. Managerial implications: The Hong Kong government should utilize the two levers of the announcement system: level of awareness and information recency. Increasing the level of awareness among the patients may not always benefit the system and there may exist a sweet spot of awareness that depends on the update window of the announcement system. Meanwhile, shortening the update window provides strong robustness to varying awareness levels. Urgent patients are less likely to be sensitive to the delay announcement than less urgent patients but those that are sensitive are more WT-averse than their less urgent counterparts. The Hong Kong government should focus on the older population and Kowloon district in promoting the ED WT announcement system.

Huiyin Ouyang

Assistant Professor of Operations Management

My research interests include stochastic modeling and analysis of service systems, healthcare operations, simulation analytics, and data-driven decision making.