Managing ICU Throughput and Understanding ICU Census

Patient demand for intensive care unit (ICU) beds is increasing faster than is ICU bed supply. Moreover, the health care system is hard-pressed to support building more ICUs and funding expensive ICU care. Higher ICU census, when not met with higher nurse staffing, is associated with higher risks of hospital-acquired infections and post-op complications for complex surgeries. Provider burnout occurs with stress related to the increased workload and time constraints.

This author presents some alternative approaches and tools to manage ICU census, inflow and throughput.

Rather than looking to lower ICU census by admitting fewer patients, the author suggests increasing ICU throughput by eliminating those processes that have no value to the patient, such as patient discharge delays when no other hospital bed is available. Another way to manage patient flow and improve mismatches between ICU demand and capacity is to alter ICU patient demand by examining ICU admission assumptions. Not all surgical procedures require the intensity of follow-up care typically delivered in an ICU.

Using census modeling techniques, the author provides a number of examples of quality improvement interventions that would allow more ICU patients to be seen with better quality and without additional physical capacity.