IDEAS home Printed from https://ideas.repec.org/a/kap/hcarem/v22y2019i4d10.1007_s10729-018-9448-4.html
   My bibliography  Save this article

The self-regulating nature of occupancy in ICUs: stochastic homoeostasis

Author

Listed:
  • Josephine Varney

    (Flinders University
    University of Adelaide)

  • Nigel Bean

    (University of Adelaide
    University of Adelaide)

  • Mark Mackay

    (Flinders University)

Abstract

As pressure on the health system grows, intensive care units (ICUs) are increasingly operating close to their capacity. This has led a number of authors to describe a link between admission and discharge behaviours, labelled variously as: ‘bumping’, ‘demand-driven discharge’, ‘premature discharge’ etc. These labels all describe the situation that arises when a patient is discharged to make room for the more acute arriving patient. This link between the admission and discharge behaviours, and other potential occupancy-management behaviours, can create a correlation between the arrival process and LOS distribution. In this paper, we demonstrate the considerable problems that this correlation structure can cause capacity models built on queueing theory, including discrete event simulation (DES) models; and provide a simple and robust solution to this modelling problem. This paper provides an indication of the scope of this problem, by showing that this correlation structure is present in most of the 37 ICUs in Australia. An indication of the size of the problem is provided using one ICU in Australia. By incorrectly assuming that the arrival process and LOS distribution are independent (i.e. that the correlation structure does not exist) for an occupancy DES model, we show that the crucial turn-away rates are markedly inaccurate, whilst the mean occupancy remains unaffected. For the scenarios tested, the turn-away rates were over-estimated by up to 46 days per year. Finally, we present simple and robust methods to: test for this correlation, and account for this correlation structure when simulating the occupancy of an ICU.

Suggested Citation

  • Josephine Varney & Nigel Bean & Mark Mackay, 2019. "The self-regulating nature of occupancy in ICUs: stochastic homoeostasis," Health Care Management Science, Springer, vol. 22(4), pages 615-634, December.
    • Handle: RePEc:kap:hcarem:v:22:y:2019:i:4:d:10.1007_s10729-018-9448-4
    DOI: 10.1007/s10729-018-9448-4
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10729-018-9448-4
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s10729-018-9448-4?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Kim, Seung-Chul & Horowitz, Ira & Young, Karl K. & Buckley, Thomas A., 1999. "Analysis of capacity management of the intensive care unit in a hospital," European Journal of Operational Research, Elsevier, vol. 115(1), pages 36-46, May.
    2. Fermín Mallor & Cristina Azcárate, 2014. "Combining optimization with simulation to obtain credible models for intensive care units," Annals of Operations Research, Springer, vol. 221(1), pages 255-271, October.
    3. 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.
    4. Wharton, Frank, 1996. "On the risk of premature transfer from coronary care units," Omega, Elsevier, vol. 24(4), pages 413-423, August.
    5. J K Cochran & K Roche, 2008. "A queuing-based decision support methodology to estimate hospital inpatient bed demand," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 59(11), pages 1471-1482, November.
    6. Barer, Morris L. & Evans, Robert G. & Hertzman, Clyde & Lomas, Jonathan, 1987. "Aging and health care utilization: New evidence on old fallacies," Social Science & Medicine, Elsevier, vol. 24(10), pages 851-862, January.
    7. Nico Dijk & Nikky Kortbeek, 2008. "On Dimensioning Intensive Care Units," Operations Research Proceedings, in: Jörg Kalcsics & Stefan Nickel (ed.), Operations Research Proceedings 2007, pages 291-296, Springer.
    8. Ridge, J. C. & Jones, S. K. & Nielsen, M. S. & Shahani, A. K., 1998. "Capacity planning for intensive care units," European Journal of Operational Research, Elsevier, vol. 105(2), pages 346-355, March.
    9. Md Asaduzzaman & Thierry Chaussalet & Nicola Robertson, 2010. "A loss network model with overflow for capacity planning of a neonatal unit," Annals of Operations Research, Springer, vol. 178(1), pages 67-76, July.
    10. P R Harper & A K Shahani, 2002. "Modelling for the planning and management of bed capacities in hospitals," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 53(1), pages 11-18, January.
    11. J D Griffiths & N Price-Lloyd & M Smithies & J E Williams, 2005. "Modelling the requirement for supplementary nurses in an intensive care unit," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 56(2), pages 126-133, February.
    12. Eren Demir & Reda Lebcir & Shola Adeyemi, 2014. "Modelling length of stay and patient flows: methodological case studies from the UK neonatal care services," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 65(4), pages 532-545, April.
    13. Litvak, Nelly & van Rijsbergen, Marleen & Boucherie, Richard J. & van Houdenhoven, Mark, 2008. "Managing the overflow of intensive care patients," European Journal of Operational Research, Elsevier, vol. 185(3), pages 998-1010, March.
    14. Gregory Dobson & Hsiao-Hui Lee & Edieal Pinker, 2010. "A Model of ICU Bumping," Operations Research, INFORMS, vol. 58(6), pages 1564-1576, December.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Jie Bai & Andreas Fügener & Jan Schoenfelder & Jens O. Brunner, 2018. "Operations research in intensive care unit management: a literature review," Health Care Management Science, Springer, vol. 21(1), pages 1-24, March.
    2. Azcarate, Cristina & Esparza, Laida & Mallor, Fermin, 2020. "The problem of the last bed: Contextualization and a new simulation framework for analyzing physician decisions," Omega, Elsevier, vol. 96(C).
    3. Fermín Mallor & Cristina Azcárate & Julio Barado, 2016. "Control problems and management policies in health systems: application to intensive care units," Flexible Services and Manufacturing Journal, Springer, vol. 28(1), pages 62-89, June.
    4. Yuta Kanai & Hideaki Takagi, 2021. "Markov chain analysis for the neonatal inpatient flow in a hospital," Health Care Management Science, Springer, vol. 24(1), pages 92-116, March.
    5. John Bowers, 2013. "Balancing operating theatre and bed capacity in a cardiothoracic centre," Health Care Management Science, Springer, vol. 16(3), pages 236-244, September.
    6. Fermín Mallor & Cristina Azcárate & Julio Barado, 2015. "Optimal control of ICU patient discharge: from theory to implementation," Health Care Management Science, Springer, vol. 18(3), pages 234-250, September.
    7. Jie Bai & Andreas Fügener & Jochen Gönsch & Jens O. Brunner & Manfred Blobner, 2021. "Managing admission and discharge processes in intensive care units," Health Care Management Science, Springer, vol. 24(4), pages 666-685, December.
    8. Fermín Mallor & Cristina Azcárate, 2014. "Combining optimization with simulation to obtain credible models for intensive care units," Annals of Operations Research, Springer, vol. 221(1), pages 255-271, October.
    9. Jing Li & Ming Dong & Wenhui Zhao, 2015. "Admissions optimisation and premature discharge decisions in intensive care units," International Journal of Production Research, Taylor & Francis Journals, vol. 53(24), pages 7329-7342, December.
    10. Vincent Knight & Izabela Komenda & Jeff Griffiths, 2017. "Measuring the price of anarchy in critical care unit interactions," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 68(6), pages 630-642, June.
    11. J D Griffiths & N Price-Lloyd & M Smithies & J E Williams, 2005. "Modelling the requirement for supplementary nurses in an intensive care unit," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 56(2), pages 126-133, February.
    12. Willoughby, Keith A. & Chan, Benjamin T.B. & Marques, Shauna, 2016. "Using simulation to test ideas for improving speech language pathology services," European Journal of Operational Research, Elsevier, vol. 252(2), pages 657-664.
    13. Yin-Chi Chan & Eric W. M. Wong & Gavin Joynt & Paul Lai & Moshe Zukerman, 2018. "Overflow models for the admission of intensive care patients," Health Care Management Science, Springer, vol. 21(4), pages 554-572, December.
    14. Valdmanis, Vivian & Bernet, Patrick & Moises, James, 2010. "Hospital capacity, capability, and emergency preparedness," European Journal of Operational Research, Elsevier, vol. 207(3), pages 1628-1634, December.
    15. Vahab Vahdat & Jacqueline Griffin & James E. Stahl, 2018. "Decreasing patient length of stay via new flexible exam room allocation policies in ambulatory care clinics," Health Care Management Science, Springer, vol. 21(4), pages 492-516, December.
    16. Md Asaduzzaman & Thierry Chaussalet & Nicola Robertson, 2010. "A loss network model with overflow for capacity planning of a neonatal unit," Annals of Operations Research, Springer, vol. 178(1), pages 67-76, July.
    17. Kim, Seung-Chul & Horowitz, Ira, 2002. "Scheduling hospital services: the efficacy of elective-surgery quotas," Omega, Elsevier, vol. 30(5), pages 335-346, October.
    18. Rachuba, Sebastian & Imhoff, Lisa & Werners, Brigitte, 2022. "Tactical blueprints for surgical weeks – An integrated approach for operating rooms and intensive care units," European Journal of Operational Research, Elsevier, vol. 298(1), pages 243-260.
    19. J K Cochran & K Roche, 2008. "A queuing-based decision support methodology to estimate hospital inpatient bed demand," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 59(11), pages 1471-1482, November.
    20. Adrian Fletcher & Dave Worthington, 2009. "What is a ‘generic’ hospital model?—a comparison of ‘generic’ and ‘specific’ hospital models of emergency patient flows," Health Care Management Science, Springer, vol. 12(4), pages 374-391, December.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:kap:hcarem:v:22:y:2019:i:4:d:10.1007_s10729-018-9448-4. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.