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Abstract Background Intensive Care Unit (ICU) capacity management is essential to provide high-quality healthcare for critically ill patients. Yet, consensus on the most favorable ICU design is lacking, especially whether ICUs should deliver dedicated or non-dedicated care. The decision for dedicated or non-dedicated ICU design considers a trade-off in the degree of specialization for individual patient care and efficient use of resources for society. We aim to share insights of a model simulating capacity effects for different ICU designs. Upon request, this simulation model is available for other ICUs. Methods A discrete event simulation model was developed and used, to study the hypothetical performance of a large University Hospital ICU on occupancy, rejection, and rescheduling rates for a dedicated and non-dedicated ICU design in four different scenarios. These scenarios either simulate the base-case situation of the local ICU, varying bed capacity levels, potential effects of reduced length of stay for a dedicated design and unexpected increased inflow of unplanned patients. Results The simulation model provided insights to foresee effects of capacity choices that should be made. The non-dedicated ICU design outperformed the dedicated ICU design in terms of efficient use of scarce resources. Conclusions The choice to use dedicated ICUs does not only affect the clinical outcome, but also rejection- rescheduling and occupancy rates. Our analysis of a large university hospital demonstrates how such a model can support decision making on ICU design, in conjunction with other operation characteristics such as staffing and quality management.

IntroductionTo investigate how the provision of additional information about the health events and procedures covered by a healthcare plan affect the level of coverage chosen by young adults taking their first full time job.MethodsUniversity students were recruited for a study at two behavioral laboratories (one located at the University of Toronto and the other located at INSEAD-Sorbonne University in Paris) in which they imagine they are making choices about the healthcare coverage associated with the taking a new job in Chicago, Illinois. Every participant made choices in four categories: Physician Care, Clinical Care, Hospital Care, and Dental Care. Participants were randomly assigned to one of two conditions: Low Detail or High Detail coverage information and they chose between three levels of coverage: Basic, Enhanced, and Superior. The study took place in March 2017 with 120 students in Toronto and 121 students in Paris.ResultsThe provision of more detailed information about the health events and procedures covered by a healthcare plan leads to a compromise effect in which participants shift their choices significantly towards Enhanced (moderate coverage) from Basic (low coverage) and Superior (high coverage). The compromise effect was observed at both locations; however, Paris participants choose significantly higher levels of coverage than Toronto participants.DiscussionProviding more detail to employees about the health events and procedures covered by a healthcare plan will increase the fraction of employees who choose the intermediate level of coverage. It is beyond the scope of this study to conclude whether this is good or bad; however, in a context where employees gravitate to either insufficient or excessive coverage, providing additional detail may reduce these tendencies.