An Econometric Analysis of Patient Flows in the Cardiac Intensive Care Unit
An Econometric Analysis of Patient Flows in the Cardiac Intensive Care Unit
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DOI：
10.1287/msom.1110.0341
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
KC DiwasSingh;C. Terwiesch
中科院分区：
文献类型：
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作者：
KC DiwasSingh;C. Terwiesch
本文探讨了心脏重症监护病房(ICU)床位容量的配给问题。我们发现，ICU患者的住院时间受ICU占用率的影响。特别是，当ICU的占有率很高时，患者可能会提前出院。这反过来又增加了患者在以后不得不重新入院到ICU的可能性。这种“反弹”对ICU的整体有效容量有影响-提前出院立即释放容量，但当患者需要重新入院时，可能会有容量要求(可能高得多)的风险。我们分析了这些容量影响，揭示了ICU是否应该采用积极的出院策略，或者它是否应该遵循旧的质量口号，并在第一次就做好。通过比较早期出院的患者和未出院的患者的总容量使用率，我们表明，对临床严重程度较低的患者应用积极的出院策略可以释放ICU的容量。然而，我们发现，当ICU容量有限时，临床严重程度高的患者再次住院的人数会增加，从而有效地减少峰值床位的容量。
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.