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ICU Admission Control: An Empirical Study of Capacity Allocation and Its Implication on Patient Outcomes

34 Pages Posted: 19 May 2012 Last revised: 18 Aug 2015

Song-Hee Kim

University of Southern California - Marshall school of Business

Carri Chan

Columbia University - Columbia Business School

Marcelo Olivares

Columbia University - Columbia Business School - Decision Risk and Operations; University of Chile - Engineering Department

Gabriel J. Escobar

Kaiser Permanente

Date Written: April 23, 2014

Abstract

This work examines the admission process to hospitals' Intensive Care Units (ICUs), which currently lacks well-defined admission criteria. A major challenge that has impeded the progress of developing ICU admission standards is that the impact of ICU admission on patient outcomes has not been well quantified, making it difficult to evaluate the performance of candidate admission strategies. Using a large patient-level dataset of over 190,000 hospitalizations across 15 hospitals, we first quantify the cost of denied ICU admission for a number of patient outcomes. We make methodological contributions in this context, improving upon previously developed instrumental variable approaches. Using the estimates from our econometric analysis, we provide a framework to evaluate the performance of various admission strategies. By simulating a hospital with 21 ICU beds, we then show that we could save about 1.9 million dollars per year by using our optimal objective policy--and hence can be used as a standard-- designed to reduce readmissions and hospital length-of-stay. We also discuss the role of physicians' discretion on the performance of alternative admission strategies.

Keywords: service operations, healthcare operations management, empirical research, dynamic programming, capacity allocation, admission control, occupancy level, quality of service

Suggested Citation

Kim, Song-Hee and Chan, Carri and Olivares, Marcelo and Escobar, Gabriel J., ICU Admission Control: An Empirical Study of Capacity Allocation and Its Implication on Patient Outcomes (April 23, 2014). Columbia Business School Research Paper No. 12/34. Available at SSRN: https://ssrn.com/abstract=2062518 or http://dx.doi.org/10.2139/ssrn.2062518

Song-Hee Kim (Contact Author)

University of Southern California - Marshall school of Business ( email )

BRI 401, 3670 Trousdale Parkway
Los Angeles, CA 90089
United States

Carri Chan

Columbia University - Columbia Business School ( email )

3022 Broadway
New York, NY 10027
United States

Marcelo Olivares

Columbia University - Columbia Business School - Decision Risk and Operations ( email )

3022 Broadway
Uris Hall, #417
New York, NY 10027
United States

HOME PAGE: http://www.columbia.edu/~mo2338/index.htm

University of Chile - Engineering Department ( email )

Republica 701 Santiago
Chile

Gabriel J. Escobar

Kaiser Permanente ( email )

CA
United States

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