The ICU will see you now: efficient–equitable admission control policies for a surgical ICU with batch arrivals

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.