Modeling the Behavior of Patients Who Leave the ED Without Being Seen

44 Pages Posted: 23 Apr 2014 Last revised: 24 Feb 2016

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

Abandonment in queues has long been recognized as having a significant impact on system performance. Nevertheless, our empirical understanding of the key drivers for abandonment, particularly in observable systems, is limited. 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. To better inform our understanding of abandonment and guide our modeling of this behavior, we study three operational drivers of abandonment, namely, waiting time, queue-length, and service rate. 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 examine the shape of the hazard function for LWBS behavior. A constant hazard function, which is equivalent to an exponential patience distribution, is commonly assumed for abandonment, but is not an accurate model for such systems. However, the Weibull distribution, particularly when parameterized by appropriate covariates, does provide a good .t. We use these findings together with a numerical study to make recommendations for simulating LWBS behavior.

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

Suggested Citation

Bolandifar, Ehsan and DeHoratius, Nicole and Olsen, Tava and Wiler, Jennifer L., Modeling the Behavior of Patients Who Leave the ED Without Being Seen (February 24, 2016). Chicago Booth Research Paper No. 12-14. 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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