Research

How important are delays in treatment for health outcomes? The case of ambulance response time and cardiovascular events

Elena Lucchese, (2023) Health Economics, https://doi.org/10.1002/hec.4791

Awards:

Abstract

The cost-effectiveness of medical treatments is not precisely known due to the compounding effect of multiple determining factors. Ambulance response time (RT) to emergency calls is exploited to learn more about the effect of the timing of treatment on health outcomes. This causal relation is identified by exploiting rainfall at the time of the ambulance run as a shock to RT. The analysis focuses on patients who have undergone a cardiac event and shows that a one-minute increase in average RT leads to 105 more deaths each year in one Italian region. Finally, the economic value of the lives that would be saved by reducing RT is quantified to facilitate policymaking. [JEL: C26, I12, I18, R41]. 

Ambulances Get Lost: the Problem of Patient Localization in Emergency Care 

Elena Lucchese

Award:

Abstract

Rapid responses in emergency increases the likelihood of clearing crimes for police and saving lives for care providers. Very little is known, however, about the determinants of response time. I take advantage from rich and comprehensive administrative data from the Liguria Emergency Medical System to discuss and estimate the problem of localization faced by ambulance drivers. I make use of a difference-in-differences identification strategy by considering two factors: (i) each ambulance mission includes two driving times: the way to go, characterized by uncertainty about the location of patient; and the way to go back: during this phase of mission the location of the destination (the hospital) is known by the driver; (ii) some locations are more difficult to locate than others: is less likely that the ambulance driver knows the location of private homes compared to public buildings. I document that the localization problem delays the response of urgent (non- deferrable) missions by 5 minutes, 30% at the average. The magnitude of the effect is not affected by the distance travelled by the ambulance. The delay is halved for non-urgent missions, when the caller is less stressed and communicates more clearly. [JEL: D29, D90, I12, I18, R41]. 

Slacking-off or Just Tired?

Work Shift and Productivity in the Emergency Department 

with Paolo Roberti

Abstract

Work schedules is a general form of coordination in organisations. In this study of emergency medical treatments dispensed by care providers working in shifts, schedules induce distortions near the end of shift. Examining how performance changes according to the level of urgency of the patient, we are able to distinguish between leisure (slacking-off) and fatigue motives as potential drivers. Fatigue appears to be an important determinant of performance. 

The Impact of MPDS on Response Delay Time And Duration of Emergency Medical Calls

A. Furgani, E. Lucchese, S. Esposito, S. Ferlito, G. Abregal, F. Ferrari, R. Sanna, S. Ruffoni, and F. Bermano 

(2016) Annals of Emergency Dispatch and Response, Vol. 4 Issue 2.

Abstract

A fast response to an emergency call is one of the main objectives of an emergency medical communication centers (EMCCs). In 2011 the MPDS®, was implemented in the Liguria Region EMCCs to manage emergency medical calls. The primary objective of the study was to evaluate whether or not the use of the MPDS has reduced the RD. The secondary objective was to evaluate the change in the DEC after the implementation of the MPDS.