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

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