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The intensive care unit (ICU) is a crucial and expensive resource largely affected by uncertainty and variability. Insufficient ICU capacity causes many negative effects not only in the ICU itself, but also in other connected departments along the patient care path. Operations research/management science (OR/MS) plays an important role in identifying ways to manage ICU capacities efficiently and in ensuring desired levels of service quality. As a consequence, numerous papers on the topic exist. The goal of this paper is to provide the first structured literature review on how OR/MS may support ICU management. We start our review by illustrating the important role the ICU plays in the hospital patient flow. Then we focus on the ICU management problem (single department management problem) and classify the literature from multiple angles, including decision horizons, problem settings, and modeling and solution techniques. Based on the classification logic, research gaps and opportunities are highlighted, e.g., combining bed capacity planning and personnel scheduling, modeling uncertainty with non-homogenous distribution functions, and exploring more efficient solution approaches.

Water network with regeneration schemes (e.g., regeneration reuse, regeneration recycling) can reduce freshwater consumption further than water network merely with direct reuse. Regeneration reuse, compared with regeneration recycling, can additionally avoid unexpected accumulation of contaminants. Owing to these features, process decomposition can help to reduce freshwater usage and wastewater discharge of regeneration reuse water systems and achieve the results, which graphical method delivers. In this article, the effect of decomposition on water-using process and further on regeneration reuse water system is briefly analyzed on the concentration-mass load diagram. Then a superstructure and three sequential mathematical models, which take process decomposition into account, are in turn developed to optimize single contaminant regeneration reuse water systems. By several examples, the reliability of the models is verified. Moreover, several decomposition strategies are summarized to realize the regeneration reuse water network, which attains the targets from graphical method. The results indicate that postregeneration concentration has a major impact on the scheme of process decomposition. V V C 2009 American Institute of Chemical Engineers AIChE J, 56: 915-929, 2010

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The intensive care unit (ICU) is one of the most crucial and expensive resources in a health care system. While high fixed costs usually lead to tight capacities, shortages have severe consequences. Thus, various challenging issues exist: When should an ICU admit or reject arriving patients in general? Should ICUs always be able to admit critical patients or rather focus on high utilization? On an operational level, both admission control of arriving patients and demand-driven early discharge of currently residing patients are decision variables and should be considered simultaneously. This paper discusses the trade-off between medical and monetary goals when managing intensive care units by modeling the problem as a Markov decision process. Intuitive, myopic rule mimicking decision-making in practice is applied as a benchmark. In a numerical study based on real-world data, we demonstrate that the medical results deteriorate dramatically when focusing on monetary goals only, and vice versa. Using our model, we illustrate the trade-off along an efficiency frontier that accounts for all combinations of medical and monetary goals. Coming from a solution that optimizes monetary costs, a significant reduction of expected mortality can be achieved at little additional monetary cost.