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OM in the News: The High Cost of Long ER Waits

June 12, 2020

Crowded emergency rooms have long been a problem in the U.S., writes The Wall Street Journal (June 9, 2020),  In our discussions of queuing theory in Module D, we typically focus on the many attributes of the waiting line–length, time, cost–and on occasion we add the cost of adding multiple servers. However, a recent study by a S. Carolina prof shows that when a new ER opens, crowding at nearby facilities instantly falls an average of 10%. When comparing mortality rates at the older ERs before and after the change, the research found that a 10% drop in patient volume leads to a 24% reduction in mortality rates in the first 30 days and a 17% reduction over 6 months.

In ERs across the U.S., many patients wait for hours to be seen, and about one in 50 leaves before receiving treatment. ER patients awaiting admission to the hospital often have to wait in hallways on gurneys, while ambulances may be turned away from busy facilities. Researchers have long sought to quantify these costs of crowding.

The drop in mortality rates could be attributed to fewer people leaving against medical advice. Ten percent less patients in the ER reduced the number of patients walking out by about 51%. That is important because about 46% of people who leave the ER without being seen still need immediate medical attention. In fact, 11% are hospitalized in the next week. Since patients often come back for care soon after they leave, that could help explain why the drop in mortality rate was most significant in the first 30 days.

The study also examined whether the drop in patent volume affected “boarding”—that is, when patients wait on stretchers, sometimes for hours, before being admitted into the hospital. But patients from the ER tend to generate less profit and consequently often have to wait anyways for beds, so the study concluded that boarding is not impacted by ER crowds.

Classroom discussion questions:

  1. Why is this study important?
  2. What OM issues are faced on a daily basis in ERs?
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