Elsevier

Surgery

Volume 146, Issue 4, October 2009, Pages 608-620
Surgery

Central Surgical Association
Using simulation to determine the need for ICU beds for surgery patients

https://doi.org/10.1016/j.surg.2009.05.021Get rights and content

Background

As the need for surgical ICU beds at the hospital increases, the mismatch between demand and supply for those beds has led to the need to understand the drivers of ICU performance.

Method

A Monte Carlo simulation study of ICU performance was performed using a discrete event model that captured the events, timing, and logic of ICU patient arrivals and bed stays.

Results

The study found that functional ICU capacity, ie, the number of occupied ICU beds at which operative procedures were canceled if they were known to require an ICU stay, was the main determinant of the wait, the number performed, and the number of cancellations of operative procedures known to require an ICU stay. The study also found that actual and functional ICU capacity jointly explained ICU utilization and the mean number of patients that should have been in the ICU that were parked elsewhere.

Conclusion

The study demonstrated the necessity of considering actual and functional ICU capacity when analyzing surgical ICU bed requirements, and suggested the need for additional research on synchronizing demand with supply. The study also reinforced the authors' sense that simulation facilitates the evaluation of trade-offs between surgical management alternatives proposed by experts and the identification of unexpected drawbacks or opportunities of those proposals.

Section snippets

Methods

To perform the study, the first author spent approximately 125 hours performing the steps explained in the following subsections; additional unmeasured time was also spent by the chief of surgical services, the chief of surgical nursing, members of the ICU bed shortage task force (listed below), and members of the hospital's information management team.

Results

An important indicator of ICU performance is the extent that waiting times for requests known to require an ICU stay, from submission of a request until the procedure, are longer than they would be if there was an unlimited number of ICU beds. To measure this, the study measured patient waiting as a function of the hospital's functional ICU capacity. These measurements were performed for patients waiting for cardiac procedures known to require an ICU stay as a proxy for all operative procedures

Discussion

The goal of this study was to identify potential avenues for improving the performance of the ICU for surgical patients by reducing cancellation of operative procedures known to require ICU stays, reducing wait times for those procedures, and improving access to the ICU. While most ICUs in Canada and in many other parts of the world mix surgical and medical patients, it was felt that an important starting point for an analysis of the need for ICU beds for surgical patients should be with an ICU

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