Topic: Clinical and Admission Decisions In emergency Rooms: Implications to Operations and Medicine

Speaker:Professor Mahesh Nagarajan, the Sauder School of Business, University of British Columbia.

Language：English

Time: 10:00 am, October 20

Venue: Room 407, Tongji Building A

Abstract:

Emergency Departments are an important and integral part of most health care systems. Both operationally and clinically, emergency departments present health care providers with high variability in the type and volume of job requirements.  We look at two aspects of an ED. First we look at how arriving patients are admitted into an ED and how they are scheduled for care. To do this, we examine several large EDs in a large HC system in N. America and empirically investigate how patients are admitted (I.e. what the priority rule for admissions looks like). We show that several commonly held clinical practices are violated and that EDs respond to incentive schemes set up by the provider rather than follow guidelines that reflect service levels for each triage. We use a carefully calibrated consumer choice model and validate it using data to model the provider decision. We then demonstrate the waiting costs that the decision makers impute in making these decisions. This has important ramifications to operations management, clinical practice and how incentive schemes provided by a health care system may affect imputations of waiting costs by decision makers.

Next, we look at variations in two important decisions made by ED physicians, namely, admission decision to hospitals from ED and test ordering behaviour. Using a data set from a large health care system, we first show that there Is significant variation in these two behaviors across ED physicians. We test if the shift, patient mix, physician experience and training are explanations for this variations and find that this is not the main cause. We show that the main cause is best predicted by inherent personality characteristics of physicians, an important one being risk aversion. We also test how such traits influence other important ED behaviour such as reaction under stress, innovation etc.