Do Care Providers Take an Individual Patient Perspective or a System Perspective? A Study of the Effect of ICU Capacity Strain on Patient Discharge

32 Pages Posted: 16 Aug 2015 Last revised: 10 Feb 2022

See all articles by Song-Hee Kim

Song-Hee Kim

Seoul National University - Business School

Edieal J. Pinker

Yale School of Management

Joan Rimar

affiliation not provided to SSRN

Date Written: February 9, 2022

Abstract

Intensive Care Units (ICUs) play a vital role in hospitals and they often have capacity strain. Using data from a major teaching hospital, we empirically examine the effect of ICU capacity strain on patient discharge. Our data has a dynamic measure of patient health status, allowing us to study the effect with two novel approaches. First, we define capacity strain using both census and patient acuity whereas prior research generally accounted for census only. Second, we examine the relationship between capacity strain and patient health status at discharge instead of longer-term outcomes. We find that 1) the number of daily discharges is affected by not only census but also percentage of acute patients; 2) capacity strain does not have an impact on discharged patients’ health status; and 3) capacity strain leads to shorter length-of-stay in the ICU, but the magnitude of the effect is shorter than half a day. That is, contradicting prior literature, we do not find evidence for aggressive premature ICU discharge behavior in our study ICU. This difference likely comes from our sophisticated measure of ICU capacity strain and our direct measure of patient status at ICU discharge. In sum, we conclude that our study ICU is finding ways to simultaneously take the individual patient perspective and system perspective into account and we further examine mechanisms that are used to achieve these dual goals. Our findings also suggest that ICUs need to track changes in patient acuity in addition to census to measure capacity strain and that future studies of ICU should take patient acuity into account in ICU capacity strain measures.

Keywords: empirical operations management; healthcare delivery; intensive care units; capacity strain; discharge; patient outcome

JEL Classification: I12

Suggested Citation

Kim, Song-Hee and Pinker, Edieal J. and Rimar, Joan, Do Care Providers Take an Individual Patient Perspective or a System Perspective? A Study of the Effect of ICU Capacity Strain on Patient Discharge (February 9, 2022). Available at SSRN: https://ssrn.com/abstract=2644600 or http://dx.doi.org/10.2139/ssrn.2644600

Song-Hee Kim

Seoul National University - Business School ( email )

Seoul
Korea, Republic of (South Korea)

Edieal J. Pinker (Contact Author)

Yale School of Management ( email )

135 Prospect Street
P.O. Box 208200
New Haven, CT 06520-8200
United States
203-436-8867 (Phone)

HOME PAGE: http://https://som.yale.edu/faculty/edieal-j-pinker

Joan Rimar

affiliation not provided to SSRN

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