ICU Admission Control: An Empirical Study of Capacity Allocation and Its Implication for Patient Outcomes

Song-Hee Kim (), Carri W. Chan (), Marcelo Olivares () and Gabriel Escobar ()
Additional contact information
Song-Hee Kim: Yale School of Management, Yale University, New Haven, Connecticut 06520
Carri W. Chan: Columbia Business School, Columbia University, New York, New York 10027
Marcelo Olivares: Universidad de Chile, Santiago, Chile
Gabriel Escobar: Division of Research, Kaiser Permanente, Oakland, California 94612

Management Science, 2015, vol. 61, issue 1, 19-38

Abstract: This work examines the process of admission to a hospital’s intensive care unit (ICU). ICUs currently lack systematic admission criteria, largely because the impact of ICU admission on patient outcomes has not been well quantified. This makes evaluating the performance of candidate admission strategies difficult. Using a large patient-level data set of more than 190,000 hospitalizations across 15 hospitals, we first quantify the cost of denied ICU admission for a number of patient outcomes. We use hospital operational factors as instrumental variables to handle the endogeneity of the admission decisions and identify important specification issues that are required for this approach to be valid. Using the quantified cost estimates, we then provide a simulation framework for evaluating various admission strategies' performance. By simulating a hospital with 21 ICU beds, we find that we could save about $1.9 million per year by using an optimal policy based on observables designed to reduce readmissions and hospital length of stay. We also discuss the role of unobserved patient factors, which physicians may discretionarily account for when making admission decisions, and show that including these unobservables could result in a more than threefold increase in benefits compared to just optimizing the policy over the observable patient factors. This paper was accepted by Serguei Netessine, operations management.

Keywords: healthcare delivery; empirical operations management; dynamic programming; capacity allocation; admission control; congestion; quality of service (search for similar items in EconPapers)
Date: 2015
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (46)

Downloads: (external link)
http://dx.doi.org/10.1287/mnsc.2014.2057 (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:inm:ormnsc:v:61:y:2015:i:1:p:19-38

Access Statistics for this article

More articles in Management Science from INFORMS Contact information at EDIRC.
Bibliographic data for series maintained by Chris Asher ().