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The Boarding Patient: Effects of ICU and Hospital Occupancy Surges on Patient Flow

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  • Elisa F. Long
  • Kusum S. Mathews

Abstract

Patients admitted to a hospital's intensive care unit (ICU) often endure prolonged boarding within the ICU following receipt of care, unnecessarily occupying a critical care bed, and thereby delaying admission for other incoming patients due to bed shortage. Using patient‐level data over two years at two major academic medical centers, we estimate the impact of ICU and ward occupancy levels on ICU length of stay (LOS), and test whether simultaneous “surge occupancy” in both areas impacts overall ICU length of stay. In contrast to prior studies that only measure total LOS, we split LOS into two individual periods based on physician requests for bed transfers. We find that “service time” (when critically ill patients are stabilized and treated) is unaffected by occupancy levels. However, the less essential “boarding time” (when patients wait to exit the ICU) is accelerated during periods of high ICU occupancy and, conversely, prolonged when hospital ward occupancy levels are high. When the ICU and wards simultaneously encounter bed occupancies in the top quartile of historical levels—which occurs 5% of the time—ICU boarding increases by 22% compared to when both areas experience their lowest utilization, suggesting that ward bed availability dominates efforts to accelerate ICU discharges to free up ICU beds. We find no adverse effects of high occupancy levels on ICU bouncebacks, in‐hospital deaths, or 30‐day hospital readmissions, which supports our finding that the largely discretionary boarding period fluctuates with changing bed occupancy levels.

Suggested Citation

  • Elisa F. Long & Kusum S. Mathews, 2018. "The Boarding Patient: Effects of ICU and Hospital Occupancy Surges on Patient Flow," Production and Operations Management, Production and Operations Management Society, vol. 27(12), pages 2122-2143, December.
  • Handle: RePEc:bla:popmgt:v:27:y:2018:i:12:p:2122-2143
    DOI: 10.1111/poms.12808
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    Cited by:

    1. 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.
    2. Mirko Kremer & Francis de Véricourt, 2022. "Mismanaging diagnostic accuracy under congestion," ESMT Research Working Papers ESMT-22-01, ESMT European School of Management and Technology.
    3. Jim G. Dai & Pengyi Shi, 2021. "Recent Modeling and Analytical Advances in Hospital Inpatient Flow Management," Production and Operations Management, Production and Operations Management Society, vol. 30(6), pages 1838-1862, June.
    4. Diwas Singh KC & Stefan Scholtes & Christian Terwiesch, 2020. "Empirical Research in Healthcare Operations: Past Research, Present Understanding, and Future Opportunities," Manufacturing & Service Operations Management, INFORMS, vol. 22(1), pages 73-83, January.
    5. Laia Bosque-Mercader & Luigi Siciliani, 2023. "The association between bed occupancy rates and hospital quality in the English National Health Service," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(2), pages 209-236, March.

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