Job Market Paper: Making complex information simple. How do triage scores affect physician behaviour in the emergency department?

Abstract

Doctors operate in high stakes environments where they need to make decisions quickly. This necessitates rapid collection and synthesis of information. Triage is one such mechanism that allows for speedy decisions. The goal of triage is to condense a vector of information into a single measure which is assigned to a patient to reflect the relative urgency of their case. Providers can then allocate emergency resources accordingly. However, triage represents a simplification of information that could obscure important details of a patients case. Does triage information change how providers allocate resources for patients? I examine a set of EDs that employ a five-point triage system. A patient’s score is based on arbitrary cut-offs of vital signs, such as the heart rate, which creates a regression discontinuity that quasi-randomly assigns a triage score. As a result of a worse triage score, I find that ED physicians increase the time they treat patients by 25% from baseline, and the amount that they order imaging tests by 10%. They reduce the probability of a patient receiving a procedure by 25%. They increase the probability of specialist consultation and admission to hospital. These changes in resource allocation suggest that the physician mitigates an increased signal of risk by collecting more information, treating less, and consulting colleagues more. There are no impacts on patient return to ED rates, suggesting increased resource allocation does not result in improved health.