Safely learning Intensive Care Unit management by using a Management Flight Simulator

This paper presents the development of the first Management Flight Simulator of an Intensive Care Unit (ICU). It allows analyzing the physician decision-making related to the admission and discharge of patients and it can be used as a learning–training tool. The discrete event simulation model developed mimics real admission and discharge processes in ICUs, and it recreates the health status of the patients by using real clinical data (instead of using a single value for the length of stay). This flexible tool, which allows recreating ICUs with different characteristics (number of beds, type of patients that arrive, congestion level...), has been used and validated by ICU physicians and nurses of four hospitals. We show through preliminary results the variability among physicians in the decision-making concerning the dilemma of the last bed, which is dealt in a broad sense: it is not only about how the last available ICU bed is assigned but also about how the physician makes decisions about the admission and discharge of patients as the ICU is getting full. The simulator is freely available on the internet to be used by any interested user (https://emi-sstcdapp.unavarra.es/ICU-simulator).