An Econometric Analysis of Patient Flows in the Cardiac ICU

35 Pages Posted: 21 Apr 2011

See all articles by Diwas Singh KC

Diwas Singh KC

Emory University - Goizueta Business School

Christian Terwiesch

University of Pennsylvania - Operations & Information Management Department

Date Written: March 4, 2011

Abstract

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 if 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.

Keywords: Healthcare Operations, Capacity Management, Quality, Productivity

Suggested Citation

KC, Diwas Singh and Terwiesch, Christian, An Econometric Analysis of Patient Flows in the Cardiac ICU (March 4, 2011). Available at SSRN: https://ssrn.com/abstract=1815527 or http://dx.doi.org/10.2139/ssrn.1815527

Diwas Singh KC (Contact Author)

Emory University - Goizueta Business School ( email )

1300 Clifton Road
Atlanta, GA 30322-2722
United States

Christian Terwiesch

University of Pennsylvania - Operations & Information Management Department ( email )

Philadelphia, PA 19104
United States

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