Critical Care Capacity Management: Understanding the Role of a Step Down Unit
Critical Care Capacity Management: Understanding the Role of a Step Down Unit
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DOI：
10.1111/poms.12825
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发表时间：
2018-05
影响因子：
5
通讯作者：
Mor Armony;Carri W. Chan;Bo Zhu
中科院分区：
文献类型：
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作者：
Mor Armony;Carri W. Chan;Bo Zhu
在医院，降级病房(SDU)在重症监护病房(ICU)和普通内外科病房之间提供中等水平的护理。由于SDU的人员配备不如ICU丰富，运营成本较低；然而，SDU也无法提供病情最重的患者所需的护理水平。医学界正在就是否以及如何使用SDU进行辩论。一方面，SDU通过为ICU后的患者提供一个安全的环境来缓解ICU的拥堵，然后他们才能稳定到足以转移到普通病房。另一方面，SDU可以从本已过度拥挤的ICU中夺走容量。在这项工作中，我们提出了一个病人流经ICU和SDU的排队模型，以确定何时需要SDU，它的大小应该是多少，以及影响这些决策的主要驱动因素是什么。使用一阶和二阶分析，我们检查了ICU中为最危重患者预留容量和由于人员需求较低而通过将护士分配到SDU而获得额外容量之间的权衡。我们发现，在某些情况下，SDU的最佳大小为零，而在其他情况下，拥有相当大的SDU可能是有益的。此外，我们确定了两个在持续发展病房规模决策中起重要作用的参数：P，它反映了持续发展病房床位的需求，以及ν，通过将护士转移到持续发展病房，获得了供应收益。我们的工作洞察为实践中看到的SDU使用差异提供了严格的理由，并强调了在为重症监护做出此类规模决定时应考虑哪些因素。
In hospitals, Step Down Units (SDUs) provide an intermediate level of care between the Intensive Care Units (ICUs) and the general medical‐surgical wards. Because SDUs are less richly staffed than ICUs, they are less costly to operate; however, they also are unable to provide the level of care required by the sickest patients. There is an ongoing debate in the medical community as to whether and how SDUs should be used. On one hand, an SDU alleviates ICU congestion by providing a safe environment for post‐ICU patients before they are stable enough to be transferred to the general wards. On the other hand, an SDU can take capacity away from the already over‐congested ICU. In this work, we propose a queueing model of patient flow through the ICU and SDU in order to determine when an SDU is needed, what size it should be, and what are the main drivers influencing these decisions. Using first‐ and second‐order analysis, we examine the tradeoff between reserving capacity in the ICU for the most critical patients and gaining additional capacity achieved by allocating nurses to the SDU due to the lower staffing requirement. We find that under some circumstances the optimal size of the SDU is zero, while in other cases, having a sizable SDU may be beneficial. Moreover, we identify two parameters which play a prominent role in the SDU sizing decision: p, which captures the demand for SDU beds, and ν, which captures the supply gains by moving nurses to the SDU. The insights from our work provide rigorous justification for the variation in SDU use seen in practice as well as highlight which factors should be considered when making such sizing decisions for critical care.