Provider Discretion and Variation in Resource Allocation: The Case of Triage Decisions

One of the most challenging environments in health care is the emergency department (ED) A key decision-maker in that context is triage nurses, who assess patient illness severity and influence wait times for medical attention. We gather novel data on the triage process across 108 EDs, including wait times, triage nurse identities and assessments, and detailed patient information and outcomes. Using quasi-random assignment to ED, we find a striking rate of "inversions," where patients who are sicker based on either ex ante information or ex post outcomes are scored as sicker and wait longer than their healthier counterparts.