ICU patient flow: To premature step-down or not? A simulation analysis

Abstract

ABSTRACTA Step-Down Unit (SDU) provides an intermediate Level of Care for patients from an Intensive Care Unit (ICU) as their condition becomes less acute. SDU congestion and upstream patient arrivals force ICU administrators to incur costs, either in the form of overstays or premature step-downs. Based on a proxy for patient acuity level called the ‘Nine Equivalents of Nursing Manpower Score (NEMS)’, patients were classified into high-acuity and low-acuity. Two patient flow policies were developed and simulated: one allowing for premature step-down actions when the system is congested and the other allowing for patient rejection actions when the system is congested. The results show that the patient-rejection policy has a net health service benefit that significantly exceeds the premature step-down policy. Based on these results, it can be concluded that premature step-down contributes to congestion downstream. Counter-intuitively, premature step-down should therefore be discouraged and patient diversion actions should be further explored as viable options for congested ICUs.KEYWORDS: Healthcarepatient flowICUSDUcongestionpremature step-down Disclosure statementNo potential conflict of interest was reported by the author(s).Additional informationFundingThe author(s) reported there is no funding associated with the work featured in this article.Notes on contributorsYawo M. KobaraYawo M. Kobara is an Assistant Professor in the Odette School of Business, University of Windsor.Felipe F. RodriguesFelipe F. Rodrigues is an Assistant Professor of Operations Management and Analytics at King's University College.Camila P. E. de SouzaCamila P. E. de Souza is Assistant Professor in Statistics and Data Science at the Department of Statistical and Actuarial Sciences at Western University in London, Ontario.David StanfordDavid Stanford is a Professor in Statistics and Data Science at the Department of Statistical and Actuarial Sciences at Western University in London.