ArticleProduction and operations management2018
The Boarding Patient: Effects of ICU and Hospital Occupancy Surges on Patient Flow.
Article in Production and operations management, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Impact of early goal-directed mobilization on ICU-acquired weakness: a meta-analysis.Frontiers in neurology · 2026Pooled it
- Implementation and feasibility evaluation of a standard set of intensive care unit discharge criteria in a prospective before-after observational pilot study.BMC health services research · 2026Observational
- Determinants of Severe Financial Distress in U.S. Acute Care Hospitals: A National Longitudinal Study.Healthcare (Basel, Switzerland) · 2026Article
- Critical emergency medicine unit: a new model to mitigate critically ill patient boarding in emergency department.Journal of anesthesia, analgesia and critical care · 2025Article
- The current state of intensive care unit discharge practices - Results of an international survey study.Frontiers in medicine · 2024Article
- Article
- The association between bed occupancy rates and hospital quality in the English National Health Service.The European journal of health economics : HEPAC : health economics in prevention and care · 2023Article
- Wait!What does that mean?: Eliminating ambiguity of delays in healthcare from an OR/MS perspective.Health systems (Basingstoke, England) · 2023Review
- Impact of a same day admission project in reducing the preoperative bed occupancy demand in a pediatric inpatient hospital.Annals of medicine and surgery (2012) · 2022Article
- Delphi study to derive expert consensus on a set of criteria to evaluate discharge readiness for adult ICU patients to be discharged to a general ward-European perspective.BMC health services research · 2022Article
- Article
- Managing admission and discharge processes in intensive care units.Health care management science · 2021Article
- Enhancing palliative care occupancy and efficiency: a quality improvement project that uses a healthcare pathway for service integration and policy development.BMJ open quality · 2021Article
- Critical emergency medicine and the resuscitative care unit.Acute and critical care · 2021Article
- The mortality of critically ill patients was not associated with inter-hospital transfer due to a shortage of ICU beds - a single-centre retrospective analysis.Journal of intensive care · 2020Article
- Reducing PICU-to-Floor Time-to-Transfer Decision in Critically Ill Bronchiolitis Patients using Quality Improvement Methodology.Pediatric quality & safetyArticle
- A sequential machine learning framework for ICU and hospital length of stay prediction from admission-time data.Digital healthArticle
Corrections and comments
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Authors and funding
2 authors.
Funding
Abstract
Patients admitted to a hospital's intensive care unit (ICU) often endure prolonged boarding within the ICU following receipt of care, unnecessarily occupying a critical care bed, and thereby delaying admission for other incoming patients due to bed shortage. Using patient-level data over two years at two major academic medical centers, we estimate the impact of ICU and ward occupancy levels on ICU length of stay (LOS), and test whether simultaneous "surge occupancy" in both areas impacts overall ICU length of stay. In contrast to prior studies that only measure total LOS, we split LOS into two individual periods based on physician requests for bed transfers. We find that "service time" (when critically ill patients are stabilized and treated) is unaffected by occupancy levels. However, the less essential "boarding time" (when patients wait to exit the ICU) is accelerated during periods of high ICU occupancy and, conversely, prolonged when hospital ward occupancy levels are high. When the ICU and wards simultaneously encounter bed occupancies in the top quartile of historical levels-which occurs 5% of the time-ICU boarding increases by 22% compared to when both areas experience their lowest utilization, suggesting that ward bed availability dominates efforts to accelerate ICU discharges to free up ICU beds. We find no adverse effects of high occupancy levels on ICU bouncebacks, in-hospital deaths, or 30-day hospital readmissions, which supports our finding that the largely discretionary boarding period fluctuates with changing bed occupancy levels.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.