Hospital Boarding Crises: The Impact of Urgent vs. Prevention Responses on Length of Stay

Temidayo Adepoju (), Anita L. Carson (), Helen S. Jin () and Christopher S. Manasseh ()
Additional contact information
Temidayo Adepoju: Rutgers Business School, Rutgers University, Newark, New Jersey 07102
Anita L. Carson: Questrom School of Business, Boston University, Boston, Massachusetts 02215
Helen S. Jin: Greater Lawrence Family Health Center, Lawrence, Massachusetts 01841
Christopher S. Manasseh: Boston Medical Center, Boston, Massachusetts 02118

Management Science, 2023, vol. 69, issue 10, 5948-5963

Abstract: Healthcare policy makers use wait-time metrics to encourage hospital managers to improve patient experience. In 2002, Massachusetts mandated that hospital managers develop processes to respond to boarding crises, which occur when emergency department (ED) patients experience long waits for inpatient beds. Performance improvement theory suggests that patients would be better served by preventing boarding crises rather than responding urgently after they occur. To empirically test this theory, we use data from a Massachusetts hospital that has two physician-based processes related to boarding and patient flow. First, to comply with the state mandate, the hospital developed processes to identify when the hospital is in a boarding crisis, a code yellow (CY), and subsequently request that physicians prioritize patient discharge (urgent response). Second, physicians can use predischarge orders, optional written communication about discharge barriers, to avoid discharge delays for patients approaching discharge (prevention response). Our data supports the existence of a trade-off between these two responses. Counter to our hypothesis, the state-mandated urgent response does not have any impact on length of stay (LOS). We also find that a CY has no impact on ED hourly occupancy, marginally decreases ED wait times, and increases boarding time. The prevention response is associated with a 26% reduction in LOS. Furthermore, we find that the urgent response reduces the likelihood of physicians’ ability to use the prevention response by 27.3%. We conclude that the state policy has unintended negative consequences that stymie hospital efforts to create longer term improvement.

Keywords: healthcare: hospitals; information systems: application contexts/sectors; government regulations; empirical operations; discharge coordination (search for similar items in EconPapers)
Date: 2023
References: Add references at CitEc
Citations:

Downloads: (external link)
http://dx.doi.org/10.1287/mnsc.2023.4724 (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:inm:ormnsc:v:69:y:2023:i:10:p:5948-5963

Access Statistics for this article

More articles in Management Science from INFORMS Contact information at EDIRC.
Bibliographic data for series maintained by Chris Asher ().