Sort of fun article out this month …

Howell MD. Managing ICU throughput and understanding ICU census. Curr Opin Crit Care 2011 Dec;17(6):626-33. [Pubmed link]

What to do with scarce ICU beds has always been a problem. It’s a real problem when you have someone who needs life support right now, but you don’t have an ICU bed to put them in. Usually, hospitals have approached this problem by

building more ICU beds .. which runs a capital cost of about US$1 million per bed just to refit a regular hospital room into an ICU bed. This is one of the reasons that ICU care runs at a measurable fraction of US GDP and ~13% of all hospital costs. (We know this thanks to Neil Halpern’s great work.)

Another approach is to focus on improving ICU throughput. It turns out that you can apply very basic operations management tools — like Little’s Law — to the ICU and they work perfectly well. Little’s law would tell us that anything that reduces ICU length of stay will effectively increase the ICU’s capacity without building new beds. Lean approaches (like removing non-value-added steps) are one approach to doing this; other ICU quality improvement approaches (like spontaneous breathing trials and better sedation management) are another, and can have really major effects an ICU capacity. For example, in our ICUs, we now take care of about 1400 more patients per year than we did in 2006 — although we haven’t built a single new ICU bed.

At any rate, this article was a chance to get to write about some of those tools that help us get more value out of the health system with less cost — a big *thanks* to the editors for letting us get some of this really important stuff into the peer-reviewed literature.