Transparent comparisons of Emergency-Department prioritization policies: integrating tail risk, target attainment, and utility analysis

Adam DeHollander, Mark Karwan and Sabrina Casucci

PLOS ONE, 2025, vol. 20, issue 12, 1-24

Abstract: Studies comparing emergency department (ED) patient prioritization rules often use single averages, which can hide important clinical trade-offs. This paper presents and demonstrates a three-part evaluation framework designed for clear, multi-faceted comparisons of prioritization policies. The framework includes: (1) statistics that account for extreme outcomes, (2) profiles showing how well time targets are met, and (3) analysis based on stakeholder priorities. We illustrate the framework in a unified discrete-event simulation of a 30-bed mixed-acuity ED to show how conclusions can change across tails, thresholds, and stakeholder preferences; the numerical results are for illustration only and are not recommendations for any specific hospital. Our main contribution is the method itself: a consistent and repeatable way to reveal different but complementary information, helping decision-makers match policies to their local goals, limits, and risk tolerance. Before implementation, future work should apply this framework using data from specific hospitals and gathering input from their stakeholders.

Date: 2025
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0326722

DOI: 10.1371/journal.pone.0326722

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