Introduction: Dedicated Neurosciences ICUs provide an institutional center for specialized care. Despite a demonstrable reduction in morbidity and mortality,dedicated Neurosciences ICUs still experience significant capacity strain with resulting supra-optimal utilization and diseconomies of scale. We present a case study in the recognition and management of capacity strain within a large Neurosciences ICU.

Methods: Excessive demand for services in a Neurosciences ICU creates significant operational issues. A Reserved Bed Pilot Program (RBPP) was implemented to maximize specialty-specific economies of scale,reduce declines due to capacity,and increase transfer volume for the neurosciences service line. Strategic key performance indicators (KPIs) were created to evaluate the efficacy of the RBPP with respect to those primary objectives. Service-line specific operational KPIs were established to evaluate changes in operational throughput for the neurosciences service-line. Hospital operations impact KPIs were created to evaluate changes in operational throughput of other service-lines.

Results: The implementation of the RBPP allowed a significant increase in accepted transfer volume to the neurosciences service-line compared to pre-pilot values (p=.02). Declines due to capacity decreased significantly(p=.01). Unit utilization significantly improved across all service-line units relative to theoretical optima (p<.03). Care regionalization was achieved,as evidenced by a significant reduction in “off service” patient placement(p=.01). Negative externalities were minimized,as evidence by a non-significant impact on the operational KPIs of the emergency department and post-anesthesia care unit(p=.54).

Conclusions: Capacity strain is a significant issue for hospital units. Reducing capacity strain can increase unit efficiency,improve resource utilization,and augment service line throughput. Implementation of a reserved bed pilot program in our Neurosciences ICU resulted in a significant improvement in service-line operations with minimal externalities at the institutional level. Its implementation has improved access to care throughout a large geographical area, while improving resource utilization and care efficiency at the institutional and service-line levels.

Patient Care: Implementation of a reserved bed paradigm can increase access to specialized care, improve the quality and efficiency of care received in a dedicated Neurosciences ICU, and prevent negative externalities on non-neuroscience service-lines. Ultimately, this will allow us to treat more patients with better results.

Learning Objectives: By the conclusion of this session, participants should be able to 1) Understand the impact of capacity strain on a Neurosciences ICU, 2) Recognize the causes of capacity strain, and 3) understand the impact of a reserved resource paradigm on unit/service-line/hospital operations.

References: Available as needed.