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Allocation of Intensive Care Unit Beds in Periods of High Demand

Author

Listed:
  • Huiyin Ouyang

    (Faculty of Business and Economics, University of Hong Kong, Hong Kong)

  • Nilay Tanık Argon

    (Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599)

  • Serhan Ziya

    (Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599)

Abstract

The objective of this paper is to use mathematical modeling and analysis to develop insights into and policies for making bed allocation decisions in an intensive care unit (ICU) of a hospital during periods when patient demand is high. We first develop a stylized mathematical model in which patients’ health conditions change over time according to a Markov chain. In this model, each patient is in one of two possible health stages, one representing the critical and the other representing the highly critical health stage. The ICU has limited bed availability and therefore when a patient arrives and no beds are available, a decision needs to be made as to whether the patient should be admitted to the ICU and if so, which patient in the ICU should be transferred to the general ward. With the objective of minimizing the long-run average mortality rate, we provide analytical characterizations of the optimal policy under certain conditions. Then, based on these analytical results, we propose heuristic methods, which can be used under assumptions that are more general than what is assumed for the mathematical model. Finally, we demonstrate that the proposed heuristic methods work well by a simulation study, which relaxes some of the restrictive assumptions of the mathematical model by considering a more complex transition structure for patient health and allowing for patients to be possibly queued for admission to the ICU and readmitted from the general ward after they are discharged.

Suggested Citation

  • Huiyin Ouyang & Nilay Tanık Argon & Serhan Ziya, 2020. "Allocation of Intensive Care Unit Beds in Periods of High Demand," Operations Research, INFORMS, vol. 68(2), pages 591-608, March.
    • Handle: RePEc:inm:oropre:v:68:y:2020:i:2:p:591-608
    DOI: 10.1287/opre.2019.1876
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    References listed on IDEAS

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    1. Carri W. Chan & Vivek F. Farias & Nicholas Bambos & Gabriel J. Escobar, 2012. "Optimizing Intensive Care Unit Discharge Decisions with Patient Readmissions," Operations Research, INFORMS, vol. 60(6), pages 1323-1341, December.
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    4. Mor Armony & Carri W. Chan & Bo Zhu, 2018. "Critical Care Capacity Management: Understanding the Role of a Step Down Unit," Production and Operations Management, Production and Operations Management Society, vol. 27(5), pages 859-883, May.
    5. Gregory Dobson & Hsiao-Hui Lee & Edieal Pinker, 2010. "A Model of ICU Bumping," Operations Research, INFORMS, vol. 58(6), pages 1564-1576, December.
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    Cited by:

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    5. David Baxter & Carter B. Casady, 2020. "A Coronavirus (COVID-19) Triage Framework for (Sub)National Public–Private Partnership (PPP) Programs," Sustainability, MDPI, vol. 12(13), pages 1-7, June.

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