The Impact of Medication Delays on Patient Health in the ICU: Estimating Marginal Effects Under Endogenous Delays

38 Pages Posted: 29 May 2020

See all articles by Lesley Meng

Lesley Meng

Yale School of Management

Krzysztof Laudanski

University of Pennsylvania - Perelman School of Medicine

Ann Huffenberger

University of Pennsylvania - Perelman School of Medicine

Christian Terwiesch

University of Pennsylvania - Operations & Information Management Department

Date Written: May 1, 2020

Abstract

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.

Suggested Citation

Meng, Lesley and Laudanski, Krzysztof and Huffenberger, Ann and Terwiesch, Christian, The Impact of Medication Delays on Patient Health in the ICU: Estimating Marginal Effects Under Endogenous Delays (May 1, 2020). Available at SSRN: https://ssrn.com/abstract=3590744 or http://dx.doi.org/10.2139/ssrn.3590744

Lesley Meng (Contact Author)

Yale School of Management ( email )

New Haven, CT 06520
United States

HOME PAGE: http://https://som.yale.edu/faculty/lesley-meng

Krzysztof Laudanski

University of Pennsylvania - Perelman School of Medicine ( email )

423 Guardian Drive
Philadelphia, PA 19104
United States

Ann Huffenberger

University of Pennsylvania - Perelman School of Medicine ( email )

423 Guardian Drive
Philadelphia, PA 19104
United States

Christian Terwiesch

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

Philadelphia, PA 19104
United States

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