Bed management in intensive care - Prospective research into the organisational influences on intensive care bed allocation

Background: Medical progress has seen the utilisation of resources expand substantially. Consequently, both economic and medical factors have to be taken into account when allocating intensive care unit (ICU) beds. This study examines the bed management within an ICU; focussing on different patient populations and the influence that bed allocation has on organisational and medical processes. Methodology: 197 allocation processes within the surgical ICU at Mannheim University Hospital were recorded prospectively over an eight-week period. A traffic light system was used to measure the current utilisation, the condition of patients and the transfer and discharge options three times a day. Results: Most in-house patient admissions were initiated by the respective surgical department, usually before planned surgeries. On 74% of all days, the utilisation of beds exceeded 90%. Those beds vacated as a result of the in-house discharging of long-term patients were re-assigned significantly faster. TISS values for long-term patients with unplanned discharges were significantly larger. 11 patients had to be readmitted, 10 of whom were short-term patients during their first stay. In all cases the vacated bed was re-assigned faster than usual. During the second stay, the length of stay was significantly increased. Conclusions: Evidence points to a permanent shortage of ICU beds. This causes a potentially ineffective allocation of resources due to a more competitive assignment strategy. It could be demonstrated that a transparent admission and discharge strategy could help to resolve this situation. Measures have been highlighted which allow for consistent decision-making within the allocation process, even in difficult situations.