Surge Capacity: Analysis of Census Fluctuations to Estimate the Number of Intensive Care Unit Beds Needed

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Abstract
Objective: To compare methods of characterizing intensive care unit (ICU) bed use and estimate the number of beds needed.Study Setting: Three geographic regions in the Canadian province of Manitoba.Study Design: Retrospective analysis of population‐based data from April 1, 2000, to March 31, 2007.Methods: We compared three methods to estimateICUbed requirements. Method 1 analyzed yearly patient‐days. Methods 2 and 3 analyzed day‐to‐day fluctuations in patient census; these differed by whether each hospital needed to independently fulfill its own demand or this resource was shared across hospitals.Principal Findings: Three main findings were as follows: (1) estimates based on yearly average usage generally underestimated the number of beds needed compared to analysis of fluctuations in census, especially in the smaller regions where underestimation ranged 25–58 percent; (2) 4–29 percent fewer beds were needed if it was acceptable for demand to exceed supply 18 days/year, versus 4 days/year; and (3) 13–36 percent fewer beds were needed if hospitals within a region could effectively shareICUbeds.Conclusions: Compared to using yearly averages, analyzing day‐to‐day fluctuations in patient census gives a more accurate picture ofICUbed use. Failing to provide adequate “surge capacity” can lead to demand that frequently and severely exceeds supply.

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