ObjectivesTo determine the optimal number of adult intensive care unit beds to reduce
patient's queue waiting time and to propose policy strategies.MethodsMultimethodological approach: (a) quantitative time series and queueing
theory were used to predict the demand and estimate intensive care unit beds
in different scenarios; (b) qualitative focus group and content analysis
were used to explore physicians' attitudes and provide insights into their
behaviors and belief-driven healthcare delivery changes.ResultsA total of 33,101 requests for 268 regulated intensive care unit beds in one
year resulted in 25% admissions, 55% queue abandonment and 20% deaths.
Maintaining current intensive care unit arrival and exit rates, there would
need 628 beds to ensure a maximum wait time of six hours. A reduction of the
current abandonment rates due to clinical improvement or the average
intensive care unit length of stay would decrease the number of beds to 471
and 366, respectively. If both were reduced, the number would reach 275
beds. The interviews generated 3 main themes: (1) the doctor's conflict:
fair, legal, ethical and shared priorities in the decision-making process;
(2) a failure of access: invisible queues and a lack of infrastructure; and
(3) societal drama: deterioration of public policies and health care
networks.ConclusionThe queue should be treated as a complex societal problem with a
multifactorial origin requiring integrated solutions. Improving intensive
care unit protocols and reengineering the general wards may decrease the
length of stay. It is essential to redefine and consolidate the regulatory
centers to organize the queue and provide available resources in a timely
manner, by using priority criteria, working with stakeholders to guarantee
clinical governance and network organization.