Benefits of Surgical Smoothing and Spare Capacity: An Econometric Analysis of Patient Flow

36 Pages Posted: 4 Sep 2016

See all articles by Diwas Singh KC

Diwas Singh KC

Emory University - Goizueta Business School

Christian Terwiesch

University of Pennsylvania - Operations & Information Management Department

Date Written: August 1, 2015

Abstract

In this study, we examine the hospital’s ability to admit patients from its emergency department. From a medical perspective, the number of patients being admitted should depend solely on the patients’ clinical conditions. Using a large scale econometric study that includes detailed operational and clinical data on all cardiac patient encounters from a set of 128 hospitals over a period of 4 years, we show that this is not the case. In particular, we find that independent of their medical condition, many emergency patients are denied hospital admission because of a lack of inpatient beds. Our analysis suggests that having one more inpatient bed at the start of a day can increase the likelihood of an emergency room patient admission by around 3% on average. We examine two policies – active discharge, and demand smoothing – that can help hospitals improve patient access. We find that some hospitals actively discharge inpatients when beds become scarce; hospitals that follow such an active discharge protocol are, on average, able to admit more patients. We also investigate to what extent the hospital’s ability to smooth its surgical schedule impacts hospital admissions. Hospitals tend to schedule their elective patients early in the week (Mondays and Tuesdays), and discharge them by the weekend in order to minimize weekend staffing, effectively maximizing bed occupancy during the middle of the week. This “weekend effect” artificially induces variability, and reduces effective system capacity. We find that by scheduling patients more uniformly over the week, hospitals can dramatically increase patient access, obviating the need for active dis-charges or additional capacity investment. Our analysis quantifies these effects, and can help hospitals in making effective capacity management decisions in order to improve patient flow.

Keywords: demand variation, adaptive service rate, demand smoothing, value of capacity, hospitals

Suggested Citation

KC, Diwas Singh and Terwiesch, Christian, Benefits of Surgical Smoothing and Spare Capacity: An Econometric Analysis of Patient Flow (August 1, 2015). Available at SSRN: https://ssrn.com/abstract=2834139 or http://dx.doi.org/10.2139/ssrn.2834139

Diwas Singh KC (Contact Author)

Emory University - Goizueta Business School ( email )

1300 Clifton Road
Atlanta, GA 30322-2722
United States

Christian Terwiesch

University of Pennsylvania - Operations & Information Management Department ( email )

Philadelphia, PA 19104
United States

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