Modeling the Behavior of Patients Who Leave the ED Without Being Seen
The Chinese University of Hong Kong (CUHK)
University of Chicago - Booth School of Business
University of Auckland
Jennifer L. Wiler
University of Colorado at Denver
December 16, 2014
Chicago Booth Research Paper No. 12-14
Abandonment in queues has long been recognized as having a significant impact on system performance. Yet, our empirical understanding of the key drivers for abandonment, particularly in observable systems, is limited. Furthermore, most models of abandonment assume that it occurs after a length of time sampled from an exogenous distribution, with no dependence on the system. However, discrete-event simulation, a commonly used tool for decision making in service systems, permits much more complex (and hence accurate) models of abandonment than those simply based on time in system. This paper studies three key drivers of abandonment, namely, waiting time, queue-length, and service rate, which are also tractable for modeling. Using operational data from a hospital emergency department, we show that all three factors affect a patient’s propensity for leaving the waiting area without being seen by a physician (LWBS). Further, these factors interact with each other in a non-linear fashion. We also examine the shape of the hazard rate curves for LWBS behavior and find that an exponential distribution, as is commonly assumed for abandonment, is likely not a good model for such systems. We use these findings to make recommendations for simulating LWBS behavior. Further, we discuss the state-of-the art for existing queueing models of abandonment and translate how our findings affect the utility of these models. The results point to the need for further queueing model development.
Number of Pages in PDF File: 33
Keywords: Healthcare operations, empirical study, abandonment, Left Without Being Seen, ED
Date posted: April 23, 2014 ; Last revised: December 17, 2014
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