Emergency Department Wait Times Research Articles

American emergency room wait times for psychiatric conditions from 2019 to 2021

Use of Emergency Departments (EDs) for psychiatric complaints has increased significantly in past decades. The onset of the COVID-19 pandemic saw large shifts in ED usage, with a relative increase in mental health complaints in EDs. This paper will investigate the difference in ED wait times for psychiatric and non-psychiatric complaints over this period. Utilized National Hospital Ambulatory Medical Care Survey (NHAMCS), from 2019 to 2021, for average wait times for psychiatric versus non-psychiatric complaints. Compared the average wait times for psychiatric complaints by region, triage status, and ICD-10 F code. There was no significant difference in the average wait times overall between these conditions (P = 0.57). People with schizophrenia or psychosis had a significantly higher wait time (P = 0.03) compared to mental health symptoms secondary to physiologic conditions. Northeastern American EDs also had prolonged wait times for psychiatric conditions (P < 0.01) Research into factors of prolonged wait times can advise quality improvements such as the implementation of evidence-based triage and workup tools, and directed psychiatric education.

193 Socio-Demographic Disparities in Emergency Department Wait Times

193 Socio-Demographic Disparities in Emergency Department Wait Times

What explains differences in average wait time in the emergency department among different racial and ethnic populations: A linear decomposition approach.

Non-Hispanic Black (NHB) and Hispanic/Latino (Hispanic) patients wait longer in the emergency department (ED) to see practitioners when compared with non-Hispanic White (NHW) patients. We investigate factors contributing to longer wait times for NHB and Hispanic patients using a linear decomposition approach. This retrospective observational study included patients presenting to one tertiary hospital ED from 2019 to 2021. Median wait times among NHW, NHB, and Hispanic were calculated with multivariable linear regressions. The extent to which demographic, clinical, and hospital factors explained the differences in average wait time among the three groups were analyzed with Blinder‒Oaxaca post-linear decomposition model. There were 310,253 total patients including 34.7% of NHW, 34.7% of NHB, and 30.6% of Hispanic patients. The median wait time in NHW was 9 min (interquartile range [IQR] 4‒47 min), in NHB was 13 min (IQR 4‒59min), and in Hispanic was 19 min (IQR 5‒78 min, p<0.001). The top two contributors of average wait time difference were mode of arrival and triage acuity level. Post-linear decomposition analysis showed that 72.96% of the NHB‒NHW and 87.77% of the Hispanic‒NHW average wait time difference were explained by variables analyzed. Compared to NHW patients, NHB and Hispanic patients typically experience longer ED wait times, primarily influenced by their mode of arrival and triaged acuity levels. Despite these recognized factors, there remains 12%‒27% unexplained factors at work, such as social determinants of health (including implicit bias and systemic racism) and many other unmeasured confounders, yet to be discovered.

Scoping review of the effectiveness of 10 high-impact initiatives (HIIs) for recovering urgent and emergency care services

IntroductionProlonged ambulance response times and unacceptable emergency department (ED) wait times are significant challenges in urgent and emergency care systems associated with patient harm. This scoping review aimed to evaluate...

Patient-Centered Care Model’s Effectiveness in Reducing Patient Waiting Time in the Emergency Department: A Systematic Literature Review

&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; The emergency department (ED) is an essential component of any hospital that offers round-the-clock urgent treatment to patients in critical condition. However, lengthy waiting times are expected, which may negatively affect the patient’s health and overall experiences. This systematic review aims to assess the effectiveness of patient-centered care (PCC) models in reducing the time patients spend waiting in the emergency room by synthesizing the available evidence. This was conducted by following the following three research objectives: (i) to identify patient-centered care models implementation in hospital settings, (ii) to assess the effectiveness of patient-centered care models in improving patient outcomes in hospital settings, and(iii) to investigate the impact of prolonged waiting time on healthcare utilization in the ED. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; In this systematic review design to be included, an article had to be: full text, in English, peer-reviewed, address the evaluation of the effectiveness of the PCC model in reducing ED wait times, and the ED. Studies were excluded if they were abstracts, not fully available, published in any language other than English, were not peer-reviewed, did not meet the date of search, and were systematic reviews. The study was conducted by computerized databases which included PubMed, MEDLINE, Embase, Scopus, Web of Science, and CINHAL were searched between April 1, 2023–April 17, 2023. The study used the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement which has been updated to PRISMA 2020, a reporting guideline designed to address the issue of inadequate systematic review reporting. All the articles that satisfied the predefined inclusion criteria were independently assessed for risk of bias by two independent reviewer. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; A systematic review design searched the literature on ED context with PCC as the intervention to reduce the waiting time. Two independent reviewers screened the articles (3,114) using the PRISMA and 27 articles were included. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Long waiting times resulted in many adverse events for patients, such as delayed treatment and poorer clinical outcomes. PCC can exert a very impressive role contribution to EDs as patients should be integrated with health care providers in their health issues and treated from all perspectives.

Does initiating care in alternate care sites decrease time to disposition in the emergency department?

During the coronavirus disease 2019 (COVID-19) pandemic surge, alternate care sites (ACS) such as the waiting room or hospital lobby were created amongst hospitals nationwide to help alleviate emergency department (ED) overflow. Despite the end of the pandemic surge, many of these ACS remain functional given the burden of prolonged ED wait times, with providers now utilizing the waiting room or ACS to initiate care. Therefore, the objective of this study is to evaluate if initiating patient care in ACS helps to decrease time to disposition. Retrospective data were collected on 61,869 patient encounters presenting to an academic medical center ED. Patients with an emergency severity index (ESI) of 1 were excluded. The "pre-ACS" or control data consisted of 38,625 patient encounters from September 30, 2018 to October 1, 2019, prior to the development of ACS, in which the patient was seen by a physician after they were brought to an assigned ED room. The "post-ACS" study cohort consisted of 23,244 patient encounters from September 30, 2022 to October 1, 2023, after the initiation of ACS, during which patients were initially seen by a provider in an ACS. ACS at this institution included the three following areas: waiting room, ambulance waiting area, and a newly constructed ACS that was built next to the ED entrance on the first floor of the hospital. The newly constructed ACS consisted of 16 care spaces each containing an upright exam chair with dividers between each care space. Door-to-disposition time (DTD) was calculated by identifying the time when the patient entered the ED and the time when disposition was decided (admission requested or patient discharged). Using regression analysis, we compared the two data sets to determine significant differences among DTD time. The largest proportion of encounters were among ESI 3 patients, that is, 56.1%. There was a significant increase in median DTD for ESI 2 and 3 patients who were seen initially in an ACS compared to those who were not seen until they were in an assigned ER room. Specifically, there was a median increase of 40.9 min for ESI 2 patients and 18.8 min for ESI 3 patients who were seen initially in an ACS (p<0.001). There was a 29-min decrease in median DTD for ESI 5 patients who were seen in ACS (p=0.09). Initiating patient care earlier in ACS did not appear to decrease DTD time for patients in the ED. Overall, the benefits of early initiation of care likely lie elsewhere within patient care and the ED throughput process.

Examining the experiences of vulnerably housed patients visiting Kingston, Ontario’s emergency departments: a qualitative analysis

IntroductionVulnerably housed individuals access emergency departments (EDs) more frequently than the general population. Despite Canada’s universal public health care system, vulnerably housed persons face structural barriers to care and experience discrimination from healthcare providers. This study examines how vulnerably housed persons perceive their experience of care in the ED and Urgent Care Center (UCC) in Kingston, Ontario and aims to develop strategies for improving care for this group.MethodsAs part of a larger mixed-methods study, narratives were collected from participants attending the ED/UCC as well as community-based partner organizations, asking them to describe an experience of a recent ED visit (< 24 months). Participants could identify as members of up to three equity-deserving groups (EDGs) (for example homeless, part of an ethnic minority, having a disability, experiencing mental health issues). Coding and thematic analysis were completed for the experiences of participants who identified as being vulnerably housed (n = 171). Results were presented back to individuals with lived experience and service providers working with clients with unstable housing.ResultsParticipants reported judgement related to a past or presumed history of mental health or substance use and based on physical appearance. They also often felt unheard and that they were treated as less than human by healthcare providers. Lack of effective communication about the ED process, wait times, diagnosis, and treatment led to negative care experiences. Participants reported positive experiences when their autonomy in care-decision making was respected. Furthermore, having a patient-centered approach to care and addressing specific patient needs, identities and priorities led to positive care experiences.ConclusionsThe ED care experiences of vulnerably housed persons may be improved through healthcare provider training related to trauma-informed and patient-centered care and communication strategies in the ED. Another potential strategy to improve care is to have advocates accompany vulnerably housed persons to the ED. Finally, improving access to primary care may lead to reduced ED visits and better longitudinal care for vulnerably housed persons.

Factors Influencing Time to Definitive Care in Hip Fracture Patients in a Rural Health System.

Current literature has not adequately addressed factors affecting wait times for hip fracture surgery in the rural setting. This study aims to assess the factors affecting admission, transit, and preoperative wait times that impact the timeliness of hip fracture surgery within a rural health system. A single-center retrospective cross-sectional study was conducted in a rural community comprising five community hospitals and two receiving hospitals. A trauma registry study included all hip fracture cases from 2019. Mean, standard deviation, median, and interquartile range were calculated for admission wait times, transit times to the receiving hospitals, and preoperative wait times in hours. Metrics based on means or medians were developed for these wait times. A total of 163 patients met the inclusion criteria. The emergency department wait times before and after admission to the community hospitals were 1 hour and 2.5hours, respectively. The transit times from the community hospitals, ranging from shorter to farther distances, to receiving hospitals were 40minutes and 1 hour, respectively. The preoperative wait time for admitted and transferred patients was 12hours. Our study outlines a methodology for establishing wait time metrics that impact surgical timeliness for hip fracture patients within a rural healthcare system. We recommend conducting comparable studies with larger sample sizes across different healthcare systems.

Patient Comments and Patient Experience Ratings Are Strongly Correlated With Emergency Department Wait Times.

Hospitals and clinicians increasingly are reimbursed based on quality of care through financial incentives tied to value-based purchasing. Patient-centered care, measured through patient experience surveys, is a key component of many quality incentive programs. We hypothesize that operational aspects such as wait times are an important element of emergency department (ED) patient experience. The objectives of this paper are to determine (1) the association between ED wait times and patient experience and (2) whether patient comments show awareness of wait times. This is a cross-sectional observational study from January 1, 2019, to December 31, 2020, across 16 EDs within a regional health care system. Patient and operations data were obtained as secondary data through internal sources and merged with primary patient experience data from our data analytics team. Dependent variables are (1) the association between ED wait times in minutes and patient experience ratings and (2) the association between wait times in minutes and patient comments including the term wait (yes/no). Patients rated their "likelihood to recommend (LTR) an ED" on a 0 to 10 scale (categories: "Promoter"=9-10, "Neutral"=7-8, or "Detractor"=0-6). Our aggregate experience rating, or Net Promoter Score (NPS), is calculated by the following formula for each distinct wait time (rounded to the nearest minute): NPS=100* (# promoters - # detractors)/(# promoters+ # neutrals+ # detractors). Independent variables for patient age and gender and triage acuity, were included as potential confounders. We performed a mixed-effect multivariate ordinal logistic regression for the rating category as a function of 30minutes waited. We also performed a logistic regression for the percentage of patients commenting on the wait as a function of 30minutes waited. Standard errors are adjusted for clustering between the 16 ED sites. A total of 50 833 unique participants completed an experience survey, representing a response rate of 8.1%. Of these respondents, 28.1% included comments, with 10.9% using the term "wait." The odds ratio for association of a 30-minute wait with LTR category is 0.83 [0.81, 0.84]. As wait times increase, the odds of commenting on the wait increase by 1.49 [1.46, 1.53]. We show policy-relevant bubble plot visualizations of these two relationships. Patients were less likely to give a positive patient experience rating as wait times increased, and this was reflected in their comments. Improving on the factors contributing to ED wait times is essential to meeting health care systems' quality initiatives.

Oncology triage utilization among patients with gynecologic cancers.

e13551 Background: Emergency department (ED) utilization among patients with cancer is associated with significant burden including financial costs, resource allocation, and the patients’ experience of time spent seeking care. Moreover, studies have demonstrated that cancer patients are commonly seen in the ED for issues that do not require inpatient management and could be managed in outpatient settings. Oncology-specific urgent care centers have previously been demonstrated to decrease ED utilization and may be a potential remedy to the time toxicity experienced by patients receiving cancer care. This retrospective review aims to identify patient characteristics, resource utilization, and disposition of patients with gynecologic cancers who present to an advanced practice provider-driven, cancer-specific urgent care center (“oncology triage”) embedded in a tertiary academic center in an urban setting. Methods: We conducted a retrospective review of all gynecologic oncology patients who presented to oncology triage for any indication from May 16, 2022 to May 16, 2023.We describe the patient population utilizing oncology triage, the services provided, and time-based outcomes to assess efficiency, including time from presentation until being roomed, time to admission, and time to undergoing imaging. Results: 104 patients with gynecologic cancer were seen in oncology triage during the study period. Most patients had ovarian (43.2%) and endometrial (42.3%) cancers, and fewer had cervical cancer (10.6%). 60.6% were on their first or second line of systemic treatment. Insurance coverage included 17.3% Medicaid, 33.7% Medicare, 46.2% private, and 2.9% were uninsured. Pain (40.4%) and nausea (31.7%) were the most common chief complaints. 25.0% and 23.1% of patients had an X-ray or CT scan ordered, respectively. Intravenous fluids (69.2%) and supportive medications (e.g., antiemetics, opiates; 51.9%) were the most frequent therapeutics administered. 19% were evaluated and reassured by provider without needing additional treatment. 35.5% of all patients seen were admitted. On average, patients were roomed and seen by the care team in 9 minutes. The average time from presentation to oncology triage to hospital admission was 5 hours and 1 minute. Conclusions: In a single-center study of oncology triage utilization among patients with a mix of gynecologic cancers, we found that an oncology-specific urgent care center evaluates and manages common acute cancer-related complaints in a timely fashion. Oncology triage offers a high-acuity patient population an alternative to the ED that is much more time efficient when compared to historic ED wait times. Our findings support oncology-specific triage as a valid model of care for a subset of common acute gynecologic cancer-related problems and highlight its potential to improve patients’ experience of their cancer care.

Quality of care and emergency department throughput during the COVID-19 pandemic in a community health system Pandemic in a Community Health System

Objective: This retrospective study explores the strategic plan formulated by AHMC Health System in California, USA, to sustain and improve quality of care and emergency department (ED) efficiency during the COVID-19 pandemic. It also analyzes the plan’s outcomes.Background: The COVID-19 pandemic has posed challenges for both individuals and healthcare industries alike, impacting decision-making and access to care. AHMC faced staff and resource shortages, patient reluctance, and difficulties adapting to rapidly evolving public health guidelines. These challenges highlighted the critical need for effective plans to maintain or improve healthcare quality and ED performance.Methods: AHMC adopted a comprehensive three-layer strategic plan in 2020. The first layer, “Pandemic Response,” focused on leadership, staff training and education, infection control, new treatments, and employee vaccination rates. The second layer, “ED Throughput,” set objectives for metrics such as door-to-doctor (door-to-doc) time, ancillary turnaround time (TAT), ED length of stay (LOS), and the left-without-being-seen (LWBS) rates. Progress was monitored through monthly improvement meetings. The third layer, “Quality Excellence,” tracked improvements in COVID-adapted objectives on quality initiatives, based on CMS Quality Star Ratings, Leapfrog Hospital Safety Grades, and Yelp review scores.Results: By 2023, the three-layer strategic plan had led to many improvements in the quality of care and ED efficiency. AHMC identified 22,287 positive COVID-19 cases, expanded its ventilator inventory by 50%, and enhanced patient outcomes by applying updated treatments. Additionally, AHMC saw a 3% reduction in ED wait times and sustained its overall patient satisfaction rates, CMS Quality Star Rating, and Leapfrog Hospital Safety Grade scores.Conclusions: AHMC’s three-layer strategic plan showed effectiveness in maintaining quality of care and ED efficiency during the COVID-19 pandemic. By focusing on “Pandemic Response,” “ED Throughput,” and “Quality Excellence,” AHMC was able to adapt to the rapidly evolving public health guidelines, expand its capacity to treat COVID-19 patients and sustain its overall patient safety, satisfaction, and quality ratings. The implementation of this plan highlights the importance of proactive and comprehensive strategies in managing healthcare crises.

Impact of Nurse Practitioner Role in Emergency Departments

Background Overcrowding and long wait times in the emergency department (ED) have resulted in decreased patient satisfaction and quality of care. One of the solutions proposed to address wait times is the introduction of the nurse practitioner (NP) role in the ED. We present a systematic mixed studies review protocol that aims to gather and analyze available knowledge on the impact of the NP role in the ED on patients, other healthcare providers, and organizations. Methods The review will employ a mixed studies analysis approach. Data will be gathered from peer-reviewed and grey literature in English with no time limit. All international publications on the impact of NP role implementation that meets the inclusion criteria in the ED setting will be included. Each study will be appraised for quality using the mixed methods appraisal tool and data extracted by two independent authors. In the presence of conflict, a third author will provide a resolution. Study characteristics and findings will be synthesized using descriptive analysis, meta-analysis, and a three-stage thematic analysis approach. The review results will be presented using the PRISMA checklist for systematic reviews. Conclusions The systematic review will present current evidence on the impact of NP role implementation in the ED setting. The results are anticipated to support decisions and policymakers in their quest to decrease ED wait times and improve the quality of patient care in healthcare settings. Keywords: Nursing, Nurse Practitioner, Emergency Department, Patient Care, Systematic Review

A Granular Approach to Optimal and Fair Patient Placement in Hospital Emergency Departments

Prolonged emergency department (ED) length of stay (LOS) is associated with detrimental effects on patient care quality and outcomes. There is evidence that certain groups of patients experience longer LOS based on their gender or race, especially with regard to the part of LOS that is attributable to waiting to be seen by a clinician. This work tackles the patient prioritization and placement aspects of ED operations with the goal of improving throughput and wait time in a fair, equitable way. We present a novel Mixed Integer Linear Programming (MILP) predictive-prescriptive formulation that incorporates a breakdown of predicted patient ED LOS into actionable pieces. We incorporate considerations for fairness and reformulate the MILP formulation into a compact and computationally tractable formulation that can be solved efficiently in real time. To deal with uncertainty, we propose a sampling-based solution, and provide provable guarantees regarding its convergence, stability and sample complexity. The proposed solution increases the throughput of the ED by [Formula: see text] and decreases the average wait time by [Formula: see text] compared to current hospital practice. In addition, the method is near-optimal in terms of throughput, and produces high-quality solutions in terms of average wait time compared to a clairvoyant oracle. Our proposed approach demonstrates desirable properties when it comes to fairness in patient prioritization, illustrating a path for addressing hidden biases in patient ED wait times and hospital operations as a whole. This work was conducted in collaboration with a large US academic medical center. Data from more than 40,000 patient visits were used to shape and evaluate the predictive-prescriptive models. An important practical contribution is translating a complex algorithm’s output into recommendations that can be operationalized in the context of existing processes in the ED. Specifically, we develop an interpretable metamodel that is trained to mimic the predictive-prescriptive algorithm’s decisions and provides a transparent set of rules for patient placement. The method will be used by the hospital to improve patient flow and quality of care as well as to support more fair and consistent bed allocation decisions.

Applications of Artificial Intelligence in Emergency Departments to Improve Wait Times: Protocol for an Integrative Living Review.

Long wait times in the emergency department (ED) are a major issue for health care systems all over the world. The application of artificial intelligence (AI) is a novel strategy to reduce ED wait times when compared to the interventions included in previous research endeavors. To date, comprehensive systematic reviews that include studies involving AI applications in the context of EDs have covered a wide range of AI implementation issues. However, the lack of an iterative update strategy limits the use of these reviews. Since the subject of AI development is cutting edge and is continuously changing, reviews in this area must be frequently updated to remain relevant. This study aims to provide a summary of the evidence that is currently available regarding how AI can affect ED wait times; discuss the applications of AI in improving wait times; and periodically assess the depth, breadth, and quality of the evidence supporting the application of AI in reducing ED wait times. We plan to conduct a living systematic review (LSR). Our strategy involves conducting continuous monitoring of evidence, with biannual search updates and annual review updates. Upon completing the initial round of the review, we will refine the search strategy and establish clear schedules for updating the LSR. An interpretive synthesis using Whittemore and Knafl's framework will be performed to compile and summarize the findings. The review will be carried out using an integrated knowledge translation strategy, and knowledge users will be involved at all stages of the review to guarantee applicability, usability, and clarity of purpose. The literature search was completed by September 22, 2023, and identified 17,569 articles. The title and abstract screening were completed by December 9, 2023. In total, 70 papers were eligible. The full-text screening is in progress. The review will summarize AI applications that improve ED wait time. The LSR enables researchers to maintain high methodological rigor while enhancing the timeliness, applicability, and value of the review. DERR1-10.2196/52612.

An Investigation into Demographic Disparities in Emergency Department Disposition Decisions

We investigate the presence of health disparities in emergency department (ED) disposition decisions and if crowding levels might have an exacerbating role. Using data from a large, academic ED, we find statistically significant associations between ED disposition decisions and patient sex, race, as well as ethnicity, with male, Caucasian, and non-Hispanic patients being more likely to be admitted to the hospital compared with, respectively, female, African-American, and Hispanic patients. In line with earlier findings in other studies, we find that longer waiting times, suggesting higher levels of ED crowding, is associated with higher rates of admission. Moreover, longer ED wait times modified sex differences, suggesting that the disposition disparity in female patients might be exacerbated when the ED is more crowded.

Novel Uses of Methadone Under the "72-Hour Rule" to Facilitate Transitions of Care and Low-Dose Buprenorphine Induction in an Outpatient Bridge Clinic.

Federal regulations restrict methadone for opioid use disorder (OUD) treatment to licensed opioid treatment programs (OTPs). However, providers in other settings can administer methadone for opioid withdrawal under the "72-hour rule" while linking to further care. Prior work has demonstrated that methadone initiation in a low-barrier bridge clinic is associated with high OTP linkage and 1-month retention rates. We describe 2 other novel applications of the 72-hour rule in which methadone withdrawal management facilitated linkage to inpatient hospitalization and outpatient buprenorphine induction. Patient 1 was a 46-year-old woman with OUD complicated by serious injection-related infections. Severe opioid withdrawal limited her ability to tolerate emergency department wait times and receive inpatient care. We administered methadone for opioid withdrawal in an outpatient bridge clinic immediately before emergency department referral; this enabled hospital admission for intravenous antibiotics and anticoagulation. Patient 2 was a 36-year-old man with OUD desiring buprenorphine treatment. He had been unable to complete traditional buprenorphine induction without experiencing precipitated withdrawal. Thus, we recommended a low-dose buprenorphine induction overlapping with a full opioid agonist. Given the patient's preference to stop using fentanyl immediately, he received 72 hours of methadone for withdrawal treatment during the induction phase and successfully transitioned to buprenorphine without significant concomitant fentanyl use. In addition to facilitating OTP linkage, on-demand 72-hour methadone administration for opioid withdrawal can reduce barriers to acute medical care and buprenorphine treatment.

Lifting the curtain on the emergency department crisis: a multi-method reception study of Larry Saves the Canadian Healthcare System

BackgroundDespite growing evidence of the potential of arts-based modalities to translate knowledge and spark discussion on complex issues, applications to health policy are rare. This study explored the potential of a research-based theatrical video to increase public capacity and motivation to engage with the complex issues that make Emergency Department wait times such an intractable problem.MethodsLarry Saves the Canadian Healthcare System is a digital musical micro-series developed from extensive research examining system-level causes of Emergency crowding and the ineffectiveness of prevailing approaches. We released individual episodes and a revised full-length version on YouTube, using organic promotion strategies and paid advertising. We used YouTube Analytics to track views, engagement and viewer demographics, and content-analyzed viewer comments. We also conducted five university-based screenings; 92 students completed questionnaires, rating Larry on 16 descriptors using a 7-point Likert scale.ResultsFrom June 2022 through May 2023, Larry garnered over 100,000 views (76,752 of the full-length version, 35,535 of episodes), 1329 likes, 2780 shares, and 139 comments. Views and watch time were higher among women and positively associated with age. Among YouTube comments, the predominating themes were praise for the video and criticism of the healthcare system. Many commenters applauded the show’s accuracy, humor, and/or resonance with their experience; several shared healthcare horror stories. Students overwhelmingly agreed with all positive and disagreed with all negative descriptors, and nearly unanimously deemed the video informative, thought-provoking, and entertaining. Most also affirmed that it had increased their knowledge, interest, and confidence to participate in discussions about healthcare issues. Neither gender, primary language, nor employment in healthcare predicted ratings, but graduate students and those 25+ years old evaluated the video most positively.DiscussionThese findings highlight the promise of research-informed musical satire to inform and invigorate discourse on an urgent health policy problem. Larry has reached tens of thousands of viewers, garnered excellent feedback, and received high student ratings. Further research should directly assess educational and behavioural outcomes and explore what facilitative strategies could maximize this knowledge translation product’s potential to foster informed, impactful policy dialogue.

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 1 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 patients who leave without being seen 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 WT rather than the currently used 95th percentile. Managerial implications: The Hong Kong government should utilize the two levers of the announcement system: the sensitive fraction of patients and information recency. Increasing the sensitive fraction can benefit the system when it is below a certain threshold level. 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 increases in the sensitive population. History: This paper has been accepted as part of the 2023 Manufacturing &amp; Service Operations Management Practice-Based Research Competition. Funding: This work was supported by the Research Grants Council of the University Grants Committee through the Collaborative Research Fund [Grant C7162-20G] and General Research Fund [Grant 17502320]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0457 .

P38 Forecasting Emergency Department Waiting Times Using Deep Neural Networks

P38 Forecasting Emergency Department Waiting Times Using Deep Neural Networks

ParallelED-A novel screening and referral intervention using emergency department wait times to identify and address unmet social needs.

People arriving at the emergency department (ED) often have unmet health-related social needs (HRSN). We implemented an intervention that used undergraduate student volunteers to screen patients in the ED waiting room (WR) for unmet social drivers of health and subsequently referred patients to community resources. This cross-sectional quality improvement study included patients who were approached to complete a HRSN screening questionnaire, subsequently referred to community resources, and followed up by phone from October 2021 to October 2022 in an ED WR of an academic medical center. Primary measures were the proportions of patients who had unmet HRSN and the proportions enrolled in a statewide database of social care resources-NCCARE360. Patient demographics and geospatial distribution were also assessed to better understand the population served. Our intervention reached 3297 unique patients, with 398 patients (12%) agreeing to complete screening. Of those screened, 93% were positive for at least one social need and 95% of the aforementioned were interested in receiving assistance. A total of 60% of those who screened positive were enrolled into NCCARE360. Persons identifying as female or non-Hispanic Black were disproportionately represented at a higher rate among those who screened positive for at least one social need, with food and housing insecurity emerging as the most common referral categories. Our results demonstrate patients' willingness to be screened in the ED WR and a high identification of HRSN. Our findings show that idle time in the ED WR can be used to identify patients with unmet HRSN and refer them to resources.