Clinical characteristics and resource utilization of ICU patients

Henning, Robert J.; McClish, Donna K.; Daly, Barbara; Nearman, Howard S.; Franklin, Cory; Jackson, David

doi:10.1097/00003246-198703000-00019

Cited by 90 publications

(27 citation statements)

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“…The ICU is an expensive resource with the cost of patient care being multiple times higher than in a regular ward (see e.g. Henning et al 1987). Consequently, many ICU's operate at high levels of occupancy, leading to increased waiting times upstream of the ICU and an overall reduction in patient throughput (see also McConnell et al 2005).…”

Section: Introductionmentioning

confidence: 99%

An Econometric Analysis of Patient Flows in the Cardiac Intensive Care Unit

Terwiesch

2012

M&SOM

208

135

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This paper explores the rationing of bed capacity in a cardiac intensive care unit (ICU). We find that the length of stay for patients admitted to the ICU is influenced by the occupancy level of the ICU. In particular, a patient is likely to be discharged early when the occupancy in the ICU is high. This in turn leads to an increased likelihood of the patient having to be readmitted to the ICU at a later time. Such "bounce-backs" have implications for the overall ICU effective capacity-an early discharge immediately frees up capacity, but at the risk of a (potentially much higher) capacity requirement when the patient needs to be readmitted. We analyze these capacity implications, shedding light on the question of whether an ICU should apply an aggressive discharge strategy or if it should follow the old quality slogan and "do it right the first time. " By comparing the total capacity usage for patients who were discharged early versus those who were not, we show that an aggressive discharge policy applied to patients with lower clinical severity levels frees up capacity in the ICU. However, we find that an increased number of readmissions of patients with high clinical severity levels occur when the ICU is capacity constrained, thereby effectively reducing peak bed capacity. Christian TerwieschThe Wharton School, University of Pennsylvania terwiesch@wharton.upenn.eduThis paper explores the rationing of bed capacity in a cardiac intensive care unit (ICU). We …nd that the length of stay for patients admitted to the ICU is in ‡uenced by the occupancy level of the ICU. In particular, a patient is likely to be discharged early when the occupancy in the ICU is high. This in turn leads to an increased likelihood of the patient having to be readmitted to the ICU at a later time. Such "bounce-backs" have implications for the overall ICU e¤ective capacity -an early discharge immediately frees up capacity, but at the risk of a (potentially much higher) capacity requirement when the patient needs to be readmitted. We analyze these capacity implications, shedding light on the question if an ICU should apply an aggressive discharge strategy or if it should follow the old quality slogan and "do it right the …rst time." By comparing the total capacity usage for patients who were discharged early versus those who were not, we show that an aggressive discharge policy applied to patients with lower clinical severity levels frees up capacity in the ICU. However, we …nd that an increased number of readmissions of patients with high clinical severity levels occur when the ICU is capacity constrained, thereby e¤ectively reducing peak bed capacity.

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Section: Introductionmentioning

confidence: 99%

An Econometric Analysis of Patient Flows in the Cardiac Intensive Care Unit

Terwiesch

2012

M&SOM

208

135

View full text Add to dashboard Cite

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“…Unnötiger Transport wird zusätzlich vermieden (Bessermann 1998). Auch ältere Studien gehen von der Notwendigkeit der örtliche Nähe und den Verbundvorteilen von ICU und HDU aus (Henning et al 1987;Berenson 1984). Auch in der österreichischen Literatur mehren sich Zweifel ob getrennte Konzepte von ICU und IMCU sinnvoll sind.…”

Section: Zur Identifikation Von Patienten Die Für Die Imcu Geeignet unclassified

Evidenzbasierte Bedarfsplanung f�r Intensivbetten

Wilhelm¹,

Narath²,

Wild³

2012

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“…[27]. Methods of identifying patients suitable for admission to such units have been proposed based on quantifying severity of illness (e. g. by severity scores) or activity of treatment (e. g. by the Therapeutic Intervention Scoring System TISS) [12,26], and guidelines have recently been published to promote safe triage of patients to intermediate care units [6].…”

Section: For Intermediate Carementioning

confidence: 99%