Implementation and validation of a new method to model voluntary
departures from emergency departments
Abstract
In literature, several organizational solutions are proposed to
determine the probability of patients’ voluntary discharge from the
emergency department. Here, the issue of self-discharge is analyzed by
modeling through the Markov theory, an innovative approach recently
applied to the healthcare field. The aim of the work is to propose a new
method to calculate the rate of voluntary discharge by defining a
generic model to describe the process of first aid using the
“behavioral” Markov chain model, a new approach that takes into
account the satisfaction of the patient. The proposed model is then
applied on MatLab and validated to a real case study at the hospital
“A. Cardarelli” of Naples. It was found that most of the risk of
self-discharge is during the wait time before the patient is seen and
for the final report; usually, once the analysis is requested, the
patient, although not very satisfied, is willing to wait longer for the
results. The model allows the description of the first aid process from
the perspective of the patient. The presented model is generic and
adaptable to each hospital facility by changing only the transition
probabilities between states.