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

32 Pages Posted: 20 Oct 2023

See all articles by Temidayo Adepoju

Temidayo Adepoju

Rutgers, The State University of New Jersey - Rutgers Business School at Newark & New Brunswick; Boston University - Questrom School of Business

Anita Tucker

Boston University - Questrom School of Business

Helen Jin

Boston University - Boston Medical Center

Chris Manasseh

Boston University - Boston Medical Center

Date Written: September 30, 2019

Abstract

Healthcare policymakers 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 pre-discharge orders (PDO), optional written communication about discharge barriers, to avoid discharge delays for patients approaching discharge (prevention response).

Our data support the existence of a tradeoff between these two responses. Counter to our hypothesis, the state-mandated urgent response does not have any impact on 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.

Note:
Funding Information: The author(s) received no financial support for the research, authorship and publication of this article.

Conflict of Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Ethical Approval: This study was approved by the Institutional Review Board of Boston University and Boston Medical Center. The collection and evaluation of patient information was performed in a Health Insurance Portability and Accountability Act (HIPAA)-compliant manner.

Keywords: Health Care; Hospitals; Information Systems; Application Contexts/Sectors; Government; Regulations; Empirical Operations; Discharge Coordination

Suggested Citation

Adepoju, Temidayo and Tucker, Anita and Jin, Helen and Manasseh, Chris, Hospital Boarding Crises: The Impact of Urgent Versus Prevention Responses on Length of Stay (September 30, 2019). Boston University Questrom School of Business Research Paper No. 3405617, Available at SSRN: https://ssrn.com/abstract=3405617 or http://dx.doi.org/10.2139/ssrn.3405617

Temidayo Adepoju (Contact Author)

Rutgers, The State University of New Jersey - Rutgers Business School at Newark & New Brunswick ( email )

Janice H. Levin Bldg., Room 121
94 Rockafeller Road
Piscataway, NJ 08854-8054
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4138470548 (Phone)

Boston University - Questrom School of Business ( email )

595 Commonwealth Avenue,
Boston, MA 02215
United States
4138470548 (Phone)

Anita Tucker

Boston University - Questrom School of Business ( email )

595 Commonwealth Avenue
Boston, MA MA 02215
United States

Helen Jin

Boston University - Boston Medical Center ( email )

One Boston Medical Center Place
Boston, MA 02118
United States

Chris Manasseh

Boston University - Boston Medical Center ( email )

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