Assessing the impact of service level when customer needs are uncertain: An empirical investigation of hospital step-down units

摘要

Hospitals are under pressure to become cost-effective. Inpatient care is categorized into intensive care units (ICUs) and general medicine/surgical wards (wards). ICUs provide intensive care and their operational costs are high - about 17% to 39% of total hospital costs. To reduce expenses, intermediate care step-down-units (SDUs) are provided to those who are not critically ill, but need continuous monitoring in a semi-critical stage. SDUs usually have one nurse per three or four patients and are less expensive than ICUs. However, SDUs are costlier than wards because of higher nurse-to-patient ratio. With SDUs becoming popular, hospital administrations need a better understanding of their benefits and best practices. The ICU/SDU/ward system can be considered as a three-level service system with heterogeneous customers. The levels are nested in the sense that the lowest level ward provides service to a subset of customers, the second level SDUs provide service to the lowest level plus additional customers and the highest-level ICUs provide service to all customers. The motive is to understand which customers are to be served at which level given the uncertainty in customer needs. The objective is to identify capacity at each level, when and how to route customers to different levels and the way customers are to be classified by identifying their needs.