Rationing Without Contemplation: Why Attention to Patient Flow Is Important and How to Make It Better

  • Michael D. HowellEmail author
  • Jennifer P. Stevens
Part of the Respiratory Medicine book series (RM, volume 18)


Inattentiveness to patient flow leads to rationing of critical care without contemplation. Many ICUs today operate at the limits of their capacity, making daily decisions about which patients can receive critical care. Historically, hospitals have dealt with this by building additional ICU beds. However, improving patient flow effectively increases ICU capacity without building additional beds, and problems with patient flow have well-documented, harmful effects on patients both in the ICU and waiting for care in the ICU. A number of tools from manufacturing and operations research allow us to understand, measure, and model patient flow, and to use this understanding to make meaningful improvements in real-world ICUs.


Communication Mathematical theory Patient safety Efficiency Interdisciplinary rounds Protocols Language 

Supplementary material


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Center for Quality, University of Chicago MedicineChicagoUSA
  2. 2.Center for Healthcare Delivery Science, Division of Pulmonary, Critical Care and Sleep MedicineBeth Israel Deaconess Medical CenterBostonUSA

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