Flexible bed allocation and performance in the intensive care unit

The beds of an intensive care unit (ICU) are a scarce resource. Stochastic patient demands for these beds and stochastic service times in their utilization make managing that resource a complex problem lacking an easy solution. The current practice in one Hong Kong hospital is for the ICU administrator to exploit the fact that there are some patients whose admission to the unit can be postponed. These are patients scheduled for an elective surgery that can be cancelled. One way to minimize the number of cancelled surgeries is to reserve some of the unit's beds for the exclusive use of the elective-surgery patients. We evaluate various bed-reservation schemes via a simulation model that is based on this ICU's historical data, and demonstrate the tradeoffs that each requires among various relevant system-performance measures. We further show how this information can be summarized in a classic efficient frontier. This frontier provides a useful medium through which the ICU administrator can communicate the rationale behind the chosen bed-allocation system to the surgeons and the ICU physicians, in an attempt to resolve the potential conflicts between them.