An Econometric Analysis of Patient Flows in the Cardiac ICU

This paper explores the rationing of bed capacity in a cardiac intensive care unit (ICU). We …nd that the length of stay for patients admitted to the ICU is in‡uenced by the occupancy level of the ICU. In particular, a patient is likely to be discharged early when the occupancy in the ICU is high. This in turn leads to an increased likelihood of the patient having to be readmitted to the ICU at a later time. Such “bounce-backs” have implications for the overall ICU e¤ective capacity –an early discharge immediately frees up capacity, but at the risk of a (potentially much higher) capacity requirement when the patient needs to be readmitted. We analyze these capacity implications, shedding light on the question if an ICU should apply an aggressive discharge strategy or if it should follow the old quality slogan and “do it right the …rst time.” By comparing the total capacity usage for patients who were discharged early versus those who were not, we show that an aggressive discharge policy increases the net peak capacity in the ICU, despite the associated increase in