Optimizing ICU Discharge Decisions with Patient Readmissions
Optimizing ICU Discharge Decisions with Patient Readmissions
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DOI：
10.2139/ssrn.1920416
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发表时间：
2011-08
期刊：
影响因子：
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通讯作者：
Carri W. Chan;V. Farias;N. Bambos;G. Escobar
中科院分区：
文献类型：
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作者：
Carri W. Chan;V. Farias;N. Bambos;G. Escobar
这项工作探讨了在能力受限的高风险环境下的不确定性的影响出院决定：重症监护病房（ICU）。新到达ICU的患者通常是非常高优先级的患者，并且如果ICU在他们到达时是满的，则可能需要使当前居住在ICU中的患者出院以容纳新入院的患者。这样出院的病人有生理恶化的风险，最终可能需要再入院;这些风险的模型目前还无法提供给供应商。这些再入院反过来又对能力有限的ICU资源施加了额外的负担。我们研究了几种不同的ICU出院策略对患者死亡率和总再入院负荷的影响。我们专注于出院规则，优先考虑病人的一些措施的基础上的危急程度假设再入院风险模型的可用性。我们使用来自5000多个实际ICU患者流的经验数据来校准我们的模型。实证研究表明，与出院决策相关的再入院风险的预测模型，结合所提出的简单指数政策，可以在实际ICU中提供非常有意义的吞吐量增益，同时保持甚至改善死亡率。我们明确提供了一个出院政策，以实现这一点。除了我们的实证工作，我们进行了严格的性能分析，我们考虑的家庭放电政策。我们表明，我们的政策是最佳的，在某些制度，否则保证再入院相关的成本不大于一个最佳的放电策略，其中的一个因素（BFP 1）是一个自然的系统利用率的措施。
This work examines the impact of discharge decisions under uncertainty in a capacity-constrained high risk setting: the intensive care unit (ICU). New arrivals to an ICU are typically very high priority patients and, should the ICU be full upon their arrival, discharging a patient currently residing in the ICU may be required to accommodate a newly admitted patient. Patients so discharged risk physiologic deterioration which might ultimately require readmission; models of these risks are currently unavailable to providers.These readmissions in turn impose an additional load on the capacity-limited ICU resources. We study the impact of several different ICU discharge strategies on patient mortality and total readmis-sion load. We focus on discharge rules that prioritize patients based on some measure of criticality assuming the availability of a model of readmission risk. We use empirical data from over 5000 actual ICU patient flows to calibrate our model. The empirical study suggests that a predictive model of the readmission risks associated with discharge decisions, in tandem with simple index policies of the type proposed can provide very meaningful throughput gains in actual ICUs while at the same time maintaining, or even improving upon, mortality rates. We explicitly provide a discharge policy that accomplishes this. In addition to our empirical work, we conduct a rigorous performance analysis for the family of discharge policies we consider. We show that our policy is optimal in certain regimes, and is otherwise guaranteed to incur readmission related costs no larger than a factor of (ˆp 1) of an optimal discharge strategy, where ˆp is a certain natural measure of system utilization.