OM in the News: Bottlenecks in the Intensive Care Unit

The Wall Street Journal (March 28,2011) reports that reengineering  has a big  role to play in the restructuring of Intensive Care Units (ICUs) in hospitals around the country. Many hospitals battle chronic capacity shortages in their ICUs, which are designed to provide constant monitoring and intervention for patients with life-threatening conditions. These critical care beds typically cost $3,000/day, several times what a normal hospital bed costs.

With rising demand and limited resources, bottlenecks in ICUs are often the norm. And they cause backups throughout the hospital. Operating rooms may have to postpone surgeries, and ERs may have to reject trauma victims if there are no ICU beds available.

The article features the Bronx’s Montefiore Medical Center and how it  reengineered its  ICU system. With 300,000  visits annually, the hospital’s emergency room is the 2nd busiest in the US.  But Montefiore is able to get by with only 78 ICU beds (a relatively small number) and claims a 33% lower mortality rate than the average hospital.

The hospital’s makeover included these features:

(1) An update on each patient every 4 hours to see if the ICU patient is really benefitting from ICU care.

(2) Teams of critical-care specialists visit each potential ICU client to determine if they really need ICU level of care. They provide “portable” ICU team coverage anywhere in the hospital if a bed is not available.

(3) Only critical-care doctors tend to patients inside the ICU. This means family doctors are not present (which some families don’t like) but survival rates have increased from 64% to 92%.

(4)  A rapid response team ( a concept pioneered in Australia), is summoned by any hospital staff member who thinks a patient’s condition is deteriorating.

If there was ever an organization in need of OM tools and analysis, of course, it would be hospitals. Hopefully this article will generate good classroom discussion.

Discussion questions:

1. What can ERs do to improve their throughput?

2. Why don’t more hospitals reengineer their ICUs?