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  1. The lack of an agreed-upon definition of an ICU bed remains a barrier to understanding bed utilization.

  2. Small ICUs or systems of ICUs are at a disadvantage due to their size, creating inefficient use of ICU beds.

  3. Availability of intermediate-care beds may impact the flow of patients into and out of ICU beds.

  4. The casemix of patients admitted to an ICU can vary dramatically. This may be driven by the overall availability of ICU beds, but will also be determined by the casemix of patients in a hospital or system.

  5. Use of intensive care beds is often driven by the specific culture of a hospital regarding the “perceived” need of an individual patient, as well as the larger cultural expectations within a given society.

  6. Optimization of ICU bed use may include decreasing the number of small ICUs operating separately, standardizing criteria for admission, and increasing alternate care options.


Care of critically ill patients is an integral part of hospital care,1 but ICU beds are a limited resource in many settings.2,3 How ICU beds are used has implications for the care of individual patients, as well as resource use and costs at the hospital and regional level. Some aspects of ICU bed utilization may be specific to individual hospitals, but others are more generalizable across hospitals and health care systems. This chapter reviews many of the factors that impact how ICU beds are used, and then discusses potential approaches to optimizing their use.

Definition of an ICU bed: The lack of an agreed on definition of an ICU bed remains a barrier to understanding bed utilization. Some countries, such as the United Kingdom, have a clear definition, describing Level 3 care (ICU-level care) as patients receiving advanced respiratory support alone, or having a minimum of two organs supported.4 Many countries do not seem to have any definitions. In the United States, there are no standard definitions, but a proposed system of categorization broadly defined the highest level of care as including “sophisticated equipment, specialized nurses, and physicians with critical care training”.5 Across developed countries, the majority of ICU beds have availability of mechanical ventilation and some form of renal support and other organ support. The meaning of an “ICU bed” in developing countries is much more questionable as it does not necessarily include resources to provide specific organ support.6 This chapter will discuss about the use of ICU beds in systems, with the ability to provide mechanical ventilation and other basic organ support as part of intensive care.


The question of the utilization of ICU beds is ultimately one of triage: understanding who is to be admitted to an ICU bed and why, and looking to optimize the use of this expensive resource while providing appropriate ...

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