Title

The ICU Will See You Now: Efficient-equitable Admission Control Policies for a Surgical ICU with Batch Arrivals

Department/School

Operations and Supply Chain Management

Date of this version

2015

Document Type

Article

Keywords

Intensive care unit, equity, Markov decision process, scheduling

Abstract

Intensive Care Units (ICUs) are frequently the bottleneck in a hospital system, limiting patient flow and negatively impacting profits. This article examines admission control policies for a surgical ICU where patients arrive in batches. This problem is formulated as a Markov Decision Process (MDP) with an objective function that allows for varying degrees of emphasis on efficiency versus equity. Equity concerns are driven by a combination of surgery type and operating surgeon and are captured in a robust manner in the proposed models. A simple and efficient heuristic solution method related to our MDP formulation is proposed that provides a performance guarantee. The proposed admissions policy is applied to a real setting motivated by the cardiothoracic surgical ICU at Mount Sinai Medical Center in New York; the results demonstrate that the ICU can achieve large equity gains with no efficiency losses.

Published in

IIE Transactions

Citation/Other Information

47(6), 586-599