Modeling the Behavior of Patients Who Leave the Emergency Department Without Being Seen

34 Pages Posted: 23 Apr 2014 Last revised: 6 May 2019

See all articles by Ehsan Bolandifar

Ehsan Bolandifar

The Chinese University of Hong Kong (CUHK)

Nicole DeHoratius

University of Chicago - Booth School of Business

Tava Olsen

University of Auckland

Jennifer L. Wiler

University of Colorado at Denver

Date Written: February 24, 2016

Abstract

Queue abandonment has a significant impact on system performance. However, the key drivers for abandonment, particularly in observable systems, are not well understood. To better inform our understanding of abandonment behavior, we study the effect of three operational drivers of abandonment from a hospital emergency department (ED), namely, waiting time, queue length, and observed service rate. We confirm that all three factors affect a patient's propensity for leaving the waiting area without being seen by a physician (LWBS), i.e., abandoning the queue. Further, these factors interact with each other in a non-linear fashion. Both ED crowding and observed service rate influence a patient's perception of waiting time. Moreover, patients are not homogenous in their abandonment response and we observe behavior that is distinct for patients with severe conditions. Specifically, patients who report to a congested ED with more severe conditions are more inclined to abandon the ED early in the process compared to patients with less severe conditions. Further, we observe that patients with severe conditions who elect to remain in the crowded ED exhibit less sensitivity to waiting time and observed service rate than other patient types. We discuss the implications of this observed abandonment behavior on ED management.

Keywords: Healthcare operations, empirical study, abandonment, Left Without Being Seen, Emergency department crowding

Suggested Citation

Bolandifar, Ehsan and DeHoratius, Nicole and Olsen, Tava and Wiler, Jennifer L., Modeling the Behavior of Patients Who Leave the Emergency Department Without Being Seen (February 24, 2016). Chicago Booth Research Paper No. 14-12. Available at SSRN: https://ssrn.com/abstract=2427309 or http://dx.doi.org/10.2139/ssrn.2427309

Ehsan Bolandifar

The Chinese University of Hong Kong (CUHK) ( email )

Shatin, N.T.
Hong Kong
Hong Kong

Nicole DeHoratius (Contact Author)

University of Chicago - Booth School of Business ( email )

5807 S. Woodlawn Avenue
Chicago, IL 60637
United States

Tava Olsen

University of Auckland ( email )

Dept of Property, 12 Grafton Rd
The University of Auckland Business School
Auckland Central, 1010
New Zealand

Jennifer L. Wiler

University of Colorado at Denver ( email )

Box 173364
1250 14th Street
Denver, CO 80217
United States

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