Capacity Pooling in Hospitals: The Hidden Consequences of Off-Service Placement

49 Pages Posted: 12 Jun 2018 Last revised: 13 Nov 2019

See all articles by Hummy Song

Hummy Song

The Wharton School, University of Pennsylvania - Operations, Information and Decisions Department

Anita Tucker

Boston University - Questrom School of Business

Ryan Graue

Harvard University - Beth Israel Deaconess Medical Center

Sarah Moravick

Harvard University - Beth Israel Deaconess Medical Center

Julius Yang

Harvard University - Beth Israel Deaconess Medical Center

Date Written: April 20, 2019

Abstract

Hospital managers struggle with the day-to-day variability in patient admissions to different clinical services, each of which typically have a fixed allocation of hospital beds. In response, many hospitals engage in capacity pooling by assigning patients from a service whose designated beds are fully occupied to an available bed in a unit designated for a different service. This “off-service placement” occurs frequently, yet its impact on patient and operational measures has not been rigorously quantified. This is, in part, because of the challenge of properly accounting for the endogenous selection of off-service patients. We use an instrumental variable approach to quantify the causal effects of off-service placement of hospitalized medical/surgical patients, having accounted for the endogeneity issues. Using data from a large academic medical center with 19.6 percent of medical/surgical patients placed off service on average, we find that off-service placement is associated with a 22.8 percent increase in remaining hospital length of stay (LOS) and a 13.1 percent increase in the likelihood of hospital readmission within 30 days. We find no significant effect on in-hospital mortality or clinical trigger (rapid response) activation. We identify longer distances to the service’s home unit as a key mechanism that drives the effect on LOS. In contrast, a mismatch in nursing specialization does not seem to explain this effect. By quantifying the effects of off-service placement on patient and operational outcomes, we enable clinicians and hospital managers to make better informed short-term decisions about off-service placement and longer-term decisions about capacity allocation.

Keywords: capacity pooling, capacity allocation, admission control, congestion, health care, empirical operations

Suggested Citation

Song, Hummy and Tucker, Anita and Graue, Ryan and Moravick, Sarah and Yang, Julius, Capacity Pooling in Hospitals: The Hidden Consequences of Off-Service Placement (April 20, 2019). Available at SSRN: https://ssrn.com/abstract=3186726 or http://dx.doi.org/10.2139/ssrn.3186726

Hummy Song (Contact Author)

The Wharton School, University of Pennsylvania - Operations, Information and Decisions Department ( email )

3730 Walnut Street
560 Jon M. Huntsman Hall
Philadelphia, PA 19104
United States

HOME PAGE: http://https://oid.wharton.upenn.edu/profile/hummy/

Anita Tucker

Boston University - Questrom School of Business ( email )

595 Commonwealth Avenue
Boston, MA MA 02215
United States

Ryan Graue

Harvard University - Beth Israel Deaconess Medical Center ( email )

330 Brookline Avenue
Boston, MA 02115
United States

Sarah Moravick

Harvard University - Beth Israel Deaconess Medical Center ( email )

330 Brookline Avenue
Boston, MA 02115
United States

Julius Yang

Harvard University - Beth Israel Deaconess Medical Center ( email )

330 Brookline Avenue
Boston, MA 02115
United States

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