Patient Sensitivity to Emergency Department Waiting Time Announcements

Problem definition: Emergency department (ED) delay announcement systems are implemented in many countries. We answer three important questions pertaining to the operations and effectiveness of such systems by studying the public hospital network and ED waiting time (WT) announcement system in Hong Kong's ‘universal’ public healthcare system: (1) How many patients are aware of (and sensitive to) the ED WT announcements? (2) How sensitive are these patients to the announced WT? (3) How can the Hong Kong government improve the WT announcement system? Methodology/results: We study over 1.3 million patient visits to the 17 tier one public EDs. We structurally estimate the fraction of patients sensitive to the announced WT and their sensitivity to the announcements as well as patient characteristics that lead to higher sensitivity. In the patient's ED choice decision, we estimate the trade-off between the travel distance to an ED and the expected WT at the ED. We find that 3.1% of the patients are sensitive to the announced WT and they are willing to travel an additional 4.8 km to save one hour of waiting. Urgent patients are less likely to be sensitive to the delay announcement than less urgent patients but those that are sensitive are more WT-averse than their less urgent counterparts. Counterfactual analysis shows that the average actual WT and number of left without being seen patients can be reduced by 4.6% and 8.5%, respectively, by increasing the fraction of sensitive patients to 15.0% and, simultaneously, reducing the announced WT assessment window to one hour from the current level of three hours. Further improvement can be achieved by providing predicted WT information based on the current level of ED crowding or less extreme past performance, median waiting time rather than the currently used 95th percentile. Managerial implications: The Hong Kong government should utilize the two levers of the announcement system: sensitive fraction of patients and information recency. Increasing the sensitive fraction can benefit the system below a certain threshold level. To promote the ED WT announcement system and increase awareness, the Hong Kong government should focus on the older population and Kowloon district. However, administrators should exercise caution when the sensitive fraction becomes large and consider implementing additional measures to mitigate the negative effects of information delay. The sensitive group of patients can unfairly be punished for their proactiveness. Shortening the announced WT assessment window and providing predicted WT are possible alternatives that not only improve overall performance but also exhibit strong robustness to increase in the sensitive population.