The Impact of Medication Delays on Patient Health in the ICU: Estimating Marginal Effects Under Endogenous Delays
38 Pages Posted: 29 May 2020
Date Written: May 1, 2020
Over the past two decades, the timely provision of care and the reduction or elimination of any form of care delays have been among the highest priorities of the healthcare community. However, just knowing that delayed care tends to have an adverse effect on patient health is not enough; the major empirical challenge of understanding the impact of delays on health outcomes is to accurately estimate their effect size. In this study, we estimate the impact of delaying necessary medication on patient health in the context of four intensive care units (ICU). Combining almost-continuous vital sign records, the medication order database, and the electronic medical record, we quantify the impact of delays in medication on patient health using an instrumental variable approach that leverages nurse shift changes and other exogenous shocks on these units. We find that medications ordered for immediate delivery in the ICU are delayed by 88 minutes on average, and we quantify the impact of some of this delay on the odds that the patient enters undesirable health states. Compared to estimates generated by a naïve OLS regression, our estimates tend to be higher, suggesting the existence of bias introduced into the data by providers prioritizing sicker patients.
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