Measuring the heterogeneous Effect of Emergency Department Boarding on Inpatient Length of Stay: Toward Efficient and Equitable Inpatient Bed Assignment
Emergency Department (ED) boarding, the practice of holding admitted patients in the ED while awaiting an inpatient bed, is a major contributor to ED crowding and raises concerns about the quality of care. When inpatient bed capacity is limited, hospitals must decide how to prioritize boarding patients for inpatient bed assignment in a way that is both efficient and equitable. This talk connects new empirical evidence to queueing-theoretic design. We quantify the heterogeneous causal effect of boarding on inpatient length of stay, a key determinant of downstream capacity, and combine these individualized effects with queueing models and policy-learning methods to design inpatient bed assignment policies that reduce overall boarding time. A key feature of our approach is the explicit integration of fairness considerations into policy design: we evaluate policies under group- and individual-level fairness criteria and study the efficiency–fairness trade-off. In a high-fidelity, trace-driven discrete-event simulation calibrated to real hospital data, the proposed policies reduce average boarding time by over 75% relative to the current assignment rule while maintaining strong fairness performance. Beyond these results, the work surfaces interesting open problems for the queueing community, including scheduling with heterogeneous wait-dependent service times and efficiency–fairness trade-offs in queue scheduling.
This is a joint work with Xiaole (Alyssa) Liu, Yosef Berlyand, and Martin Copenhaver.
Jing Dong
Prof. Jing Dong is the DeRosa Family Associate Professor of Business in the Decision, Risk, and Operations Division at Columbia Business School. Her research lies at the intersection of applied probability and service operations, with a particular focus on data-driven stochastic modeling for healthcare systems. She has developed analytical and simulation-based methods to improve patient flow and support decision-making in complex service environments. Her work advances both the theory and practice of service operations management.
Jing Dong | Columbia Business School
Zoom Link: https://ivey-uwo.zoom.us/j/94388624448?pwd=wEaBo5rqGbLoSTLfIgEFiYPNfEa2Kb.1
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