Universität zu Köln

Bai, Jie ORCID: 0000-0003-2380-1065, Fuegener, Andreas, Goensch, Jochen, Brunner, Jens O. ORCID: 0000-0002-2700-4795 and Blobner, Manfred ORCID: 0000-0002-0370-5247 (2021). Managing admission and discharge processes in intensive care units. Health Care Manag. Sci., 24 (4). S. 666 - 686. NEW YORK: SPRINGER. ISSN 1572-9389

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Abstract

The intensive care unit (ICU) is one of the most crucial and expensive resources in a health care system. While high fixed costs usually lead to tight capacities, shortages have severe consequences. Thus, various challenging issues exist: When should an ICU admit or reject arriving patients in general? Should ICUs always be able to admit critical patients or rather focus on high utilization? On an operational level, both admission control of arriving patients and demand-driven early discharge of currently residing patients are decision variables and should be considered simultaneously. This paper discusses the trade-off between medical and monetary goals when managing intensive care units by modeling the problem as a Markov decision process. Intuitive, myopic rule mimicking decision-making in practice is applied as a benchmark. In a numerical study based on real-world data, we demonstrate that the medical results deteriorate dramatically when focusing on monetary goals only, and vice versa. Using our model, we illustrate the trade-off along an efficiency frontier that accounts for all combinations of medical and monetary goals. Coming from a solution that optimizes monetary costs, a significant reduction of expected mortality can be achieved at little additional monetary cost.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bai, Jie UNSPECIFIED orcid.org/0000-0003-2380-1065 UNSPECIFIED Fuegener, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Goensch, Jochen UNSPECIFIED UNSPECIFIED UNSPECIFIED Brunner, Jens O. UNSPECIFIED orcid.org/0000-0002-2700-4795 UNSPECIFIED Blobner, Manfred UNSPECIFIED orcid.org/0000-0002-0370-5247 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-590637
DOI:	10.1007/s10729-021-09560-6
Journal or Publication Title:	Health Care Manag. Sci.
Volume:	24
Number:	4
Page Range:	S. 666 - 686
Date:	2021
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1572-9389
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CRITICALLY-ILL PATIENTS; ICU ADMISSION; CAPACITY MANAGEMENT; DELAYED ADMISSION; ELECTIVE-SURGERY; TRIAGE; OPERATIONS; DECISIONS; MODEL; ALLOCATION Multiple languages Health Policy & Services Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59063