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A cost sensitive inpatient bed reservation approach to reduce emergency department boarding times

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Abstract

Emergency departments (ED) in hospitals are experiencing severe crowding and prolonged patient waiting times. A significant contributing factor is boarding delays where admitted patients are held in ED (occupying critical resources) until an inpatient bed is identified and readied in the admit wards. Recent research has suggested that if the hospital admissions of ED patients can be predicted during triage or soon after, then bed requests and preparations can be triggered early on to reduce patient boarding time. We propose a cost sensitive bed reservation policy that recommends optimal bed reservation times for patients. The policy relies on a classifier that estimates the probability that the ED patient will be admitted using the patient information collected and readily available at triage or right after. The policy is cost sensitive in that it accounts for costs associated with patient admission prediction misclassification as well as costs associated with incorrectly selecting the reservation time. Results from testing the proposed bed reservation policy using data from a VA Medical Center are very promising and suggest significant cost saving opportunities and reduced patient boarding times.

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Notes

  1. For exposition clarity, we first assume that the target ward-bed will be ready for the ED patient in T ∗ R time units upon the request from the triage staff. However, it is possible that a bed may not be available at T ∗ R but will available later, e.g., T R  > T ∗ R . We will address this scenario in the end of this section.

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Acknowledgments

We thank the reviewers and the associate editor for excellent comments and suggestions. Their input allowed us to significantly enhance the quality of the manuscript.

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Authors and Affiliations

  1. Industrial & Systems Engineering Department, Wayne State University, Detroit, MI, 48202, USA

    Shanshan Qiu, Ratna Babu Chinnam & Alper Murat

  2. John D. Dingell VA Medical Center, Detroit, MI, USA

    Bassam Batarse

  3. VA-CASE, Detroit, MI, USA

    Hakimuddin Neemuchwala & Will Jordan

Authors
  1. Shanshan Qiu
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  2. Ratna Babu Chinnam
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Corresponding author

Correspondence to Ratna Babu Chinnam.

Appendix: Complaint Codes Used by Our Study

Appendix: Complaint Codes Used by Our Study

Below we provide the list of ‘complaint codes’ which are used to match the free text complaints in our data. All these codes are used as binary input on our models. Part 1 includes the codes from the reference [44], and part 2 includes the codes newly generated in this study.

  1. 1.

    Part 1: Existing complaint codes from [44]

    Abdominal pain, flank pain, overdose (intentional), abdominal problems, fluid/nutrition alteration, peripheral vascular/leg pain,allergies/hives/med reaction/sting, foreign body, procedure, assault/rape, follow-up , psychiatric/social problems, back pain, genito-urinary problem, respiratory problems, bites, gun-shot wound ,skin complaint/trauma, body aches, gynecological problem, stabbing, burns, headache, stroke/CVA, cardiac arrest, hemorrhage, substance abuse, cardio-vascular complaint, industrial/machinery accidents, fainting/syncope, chest pain, infection, temperature related convulsions, seizures, ingestion (accidental), traffic injury, dental toothache, laceration, traumatic injuries specific (FT), diabetic problems, medication refill , unconsciousness, (specific) diagnosis (FT), neck pain, unknown problem (man down), dizzy, needle stick, vaginal bleeding, ear/nose/throat problems, neurological complaint , weakness, eye problem, obstetrical problem, fall, orthopedic injury, fever, other (FT).

  2. 3.

    Part 2: Newly generated complaint codes

    Abnormal lab, blood pressure, cold/flu, ankle pain, foot pain, hip pain, knee pain, hand pain, arm pain, groin pain, constipation, consultation, cyst/lump, decreased responsiveness, diarrhea, digestion related, drowsiness/lethargy, lib/extremity related, medical side effect, mental status, multiple complaints, muscle/skeletal related, nausea/vomiting, procedure in, procedure out, shoulder pain, tumor/cancer related, internal organ related/pathological issue, acute organ/pathological issue, abnormal behavior, acute/severe, arm pain, abscess, chest discomfort, anal/rectum abscess, congestion, blood clot, dementia, face related, discharge, fatigue, metabolic problem, skin related, shortness of breath, rectum/anal bleeding, groin pain, epigastria pain, detox, cough, blood sugar, acute infection, confusion, gout, urinary track infection, general discomfort.

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Qiu, S., Chinnam, R.B., Murat, A. et al. A cost sensitive inpatient bed reservation approach to reduce emergency department boarding times. Health Care Manag Sci 18, 67–85 (2015). https://doi.org/10.1007/s10729-014-9283-1

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  • DOI: https://doi.org/10.1007/s10729-014-9283-1

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