Managing admission and discharge processes in intensive care units

Artikel

The intensive care unit (ICU) is one of the most crucial and expensive resources in a health care system. While high fixed costs usually lead to tight capacities, shortages have severe consequences. Thus, various challenging issues exist: When should an ICU admit or reject arriving patients in general? Should ICUs always be able to admit critical patients or rather focus on high utilization? On an operational level, both admission control of arriving patients and demand-driven early discharge of currently residing patients are decision variables and should be considered simultaneously. This paper discusses the trade-off between medical and monetary goals when managing intensive care units by modeling the problem as a Markov decision process. Intuitive, myopic rule mimicking decision-making in practice is applied as a benchmark. In a numerical study based on real-world data, we demonstrate that the medical results deteriorate dramatically when focusing on monetary goals only, and vice versa. Using our model, we illustrate the trade-off along an efficiency frontier that accounts for all combinations of medical and monetary goals. Coming from a solution that optimizes monetary costs, a significant reduction of expected mortality can be achieved at little additional monetary cost.

Angaben zum Objekt

• Sprache: Englisch

Verweise und Beziehungen

• Erschienen in: Journal: Health Care Management Science ; ISSN: 1572-9389 ; Volume: 24 ; Year: 2021 ; Issue: 4 ; Pages: 666-685 ; New York, NY: Springer US

Klassifikation und Themen

• Klassifikation: Medizin, Gesundheit
• Thema: Intensive care unit ; Admission and discharge decisions ; Markov decision process ; Dynamic programming ; Operations research

Beteiligte, Orts- und Zeitangaben

• Ereignis: Geistige Schöpfung
• (wer): Bai, Jie ; Fügener, Andreas ; Gönsch, Jochen ; Brunner, Jens O. ; Blobner, Manfred
• Ereignis: Veröffentlichung
• (wer): Springer US
• (wo): New York, NY
• (wann): 2021

Weitere Informationen

• DOI: doi:10.1007/s10729-021-09560-6
• Letzte Aktualisierung: 10.03.2025, 11:45 MEZ