The Effect of Communication and Transparency on Emergency Department Testing and Length of Stay

by Jordi Blanes i Vidal, Miguel Espinosa, Sergio Prada

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-13% lenght of stay -10% tests ordered +17% patients satisfaction

Abstract: Organisations typically solve problems with the inputs of many different experts, which requires timely communication between them. We estimate the effect of increasing the speed and transparency of internal communication on performance, in the Emergency Department of a leading hospital. Specifically, we study the effect of introducing a dashboard alerting that the results of the lab tests ordered have become available. We find that the introduction of this simple technology decreased the average length of stay in the ED by around 13%. A mediation analysis reveals that this decrease occurred largely through the channel of making doctors order less tests. Patient satisfaction increased and doctors were less likely to admit patients to the main hospital.

Main problem 1: Doctors order too many tests. This is organizationally inefficient and very costly for the system. 

Main problem 2: There are communication frictions between the laboratory and the emergency room. In particular, when a doctor orders a test, she is not told when the results are ready. Instead, the doctor needs to go and check manually in a series of screens for the specific patient. This is inefficient. 

We carry out an experiment in one leading hospital in Colombia. The hospital has two emergency rooms. In one room, we put a screen that publicly (only for medical staff) shows the results of each test for each patient. 

Main Result 1: the length of stay (most important DV in this setting) decrease 13% vis a vis the other room. 

Main Result 2: this comes from a reduction in the laboratory test ordered. There seems to be some peer effect pressure going on. For instance, the reduction in length of stay comes uniquely from those patients for which at least one test is ordered. It also comes from doctors that have stronger career concerns and therefore more likely to react to this type of pressure.