Emergency Care Efficiency vs. Quality: Uncovering Hidden Consequences of Fast-Track Routing Decisions
利用加拿大两家医院两年数据，发现急诊快速通道分流决策受运营状态影响，虽能提升效率（缩短停留时间、降低离院率），但导致高复杂度患者48小时再就诊率上升8.2%，中复杂度患者上升2.3%，揭示了效率与质量的权衡。
Problem definition: This work aims to examine the role of emergency department (ED) operational status related to congestion in fast-track (FT) routing decisions and the subsequent effects on patient outcomes. Methodology/results: In this paper, we utilize a two-year data set from two hospital EDs in Alberta, Canada, and adopt an instrumental variable approach to examine the effects of FT routing decisions on patient outcomes. Based on the empirical findings, we utilize a data-calibrated simulation to compare the performance of different routing policies. First, our study reveals that FT routing decisions are not purely clinically driven, and ED operational status is also associated with FT routing decisions. Second, being routed to FT can improve ED efficiency by reducing the average length of stay and left without being seen rates. However, this efficiency improvement comes at the cost of potential quality decline. In particular, being routed to the FT leads to an 8.2% increase in the 48-hour revisit rate for the high-complexity group and a 2.3% increase for the medium-complexity group. Third, we delve into the mechanisms behind observed patient outcomes and find that physicians in the FT area may prioritize expediting patient flow by simplifying patient diagnosis and treatment procedures. Consequently, the quality of care may be compromised for high- and medium-complexity patients. Finally, our simulation findings highlight the importance of selecting the “right” patients to be routed to the FT unit. To this end, the complexity-based classification method and dynamic routing policies emerge as promising avenues. Managerial implications: Our findings call for immediate attention from healthcare practitioners to carefully balance the trade-off between emergency care efficiency and quality, emphasizing the necessity of selecting the right patients for routing. Funding: This study is partially supported by the Hong Kong Research Grants Council [Grants GRF 11508921 and CRF C7162-20G]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0440 .