Paper Info
Title
The Diseconomies of Queue Pooling: An Empirical Investigation of Emergency Department Length of Stay
Abstract
AbstractWe conduct an empirical investigation of the impact of queue management on patients' average wait time and length of stay LOS. Using an emergency department's ED patient-level data from 2007 to 2010, we find that patients' average wait time and LOS are longer when physicians are assigned patients under a pooled queuing system with a fairness constraint compared to a dedicated queuing system with the same fairness constraint. Using a difference-in-differences approach, we find the dedicated queuing system is associated with a 17% decrease in average LOS and a 9% decrease in average wait time relative to the control group-a 39-minute reduction in LOS and a four-minute reduction in wait time for an average patient of medium severity in this ED. Interviews and observations of physicians suggest that the improved performance stems from the physicians' increased ownership over patients and resources that is afforded by a dedicated queuing system, which enables physicians to more actively manage the flow of patients into and out of ED beds. Our findings suggest that the benefits from improved flow management in a dedicated queuing system can be large enough to overcome the longer wait time predicted to arise from nonpooled queues. We conduct additional analyses to rule out alternate explanations for the reduced average wait time and LOS in the dedicated system, such as stinting and decreased quality of care. Our paper has implications for healthcare organizations and others seeking to reduce patient wait time and LOS without increasing costs. This paper was accepted by Serguei Netessine, operations management.
Year
DOI
Venue
2015
10.1287/mnsc.2014.2118
Periodicals
Keywords
Field
DocType
pooling,fairness,queue management,strategic servers,empirical operations,healthcare
Health care,Economics,Emergency department,Pooling,Queue,Flow management,Diseconomies of scale,Queue management system,Service delivery framework,Operations management
Journal
Volume
Issue
ISSN
61
12
0025-1909
Citations 
PageRank 
References 
7
0.50
19
Authors
3
Name
Order
Citations
PageRank
Hummy Song191.56
Anita L. Tucker2666.10
Karen L. Murrell390.88