Patient Throughput: Don’t Let Your ICU Become a Bottleneck
Lisa-Mae Williams, PhD, RN | May 1, 2025
Are your patients taking up an ICU bed for longer than necessary?
Your intensive care unit is meant to be reserved for the patients with the most acute clinical needs, with round-the-clock surveillance and experienced nurses and intensivists available to provide emergent care when interventions are required.
In an ideal scenario, patients would be moved out of the ICU as soon as their acuity needs change. Unfortunately, mitigating factors often complicate patient transfer.
I’d like to look at the typical circumstances affecting ICU length of stay (LOS) and offer a solution your hospital might benefit from in the long term.
A Staffing Challenge
To a certain extent, many of the challenges affecting ICU patient throughput boil down to staffing. One large bottleneck is at the point of discharge. When a patient is ready to be discharged or moved to a standard inpatient bed, a series of events is triggered.
A physician will need to provide the approval necessary for the patient to be discharged or transferred. A nurse or some other member of the care team will need to acquire and document additional patient vitals, and then a team member, typically also a nurse, will need to meet with the patient or family member to go over the post-intensive care plan and any additional instructions.
In an ideal state, hospitals would have enough staff to ensure each event can occur like clockwork. But that is hardly the case in modern healthcare, which is suffering from a severe labor shortage, particularly among nursing staff. Nurses’ patient ratios have been exceptionally high since COVID and their ranks continue to suffer from burnout to an inordinate degree.
Each step in the above process takes time, and because the patient will have been stabilized before they’re transferred, the needs of patients requiring immediate intervention often take precedence. This can lead the patient to languish in a high-acuity bed for hours or days longer than necessary.
This has a domino effect within the hospital, as high-acuity patient beds remain occupied by low-acuity patients (the issue can be exacerbated further if the inpatient bed they’re being transferred to is also occupied). If your ICU bed space is limited, this can prevent incoming high-acuity patients from getting the bed and the treatment they need.
If you don’t have the beds necessary to transfer all these patients needing to be moved, know that you’re not alone. A limited supply of hospital beds is something that’s happening at the national level, with new research from UCLA predicting a critical shortage by 2032 unless widespread changes occur.
Does Tele-Critical Care Provide the Answer?
It’s not as simple as throwing money and staff at the patient throughput problem, because there’s not enough of either of those things to go around.
For many hospitals, tele-critical care provides a lifeline for getting patients discharged and transferred to the appropriate level of acuity faster.
Leapfrog, in advising upon the requirements necessary for achieving the standard for ICU Physician Staffing (IPS), makes note of how the presence of intensivists via telemedicine can supplement the work of on-site team members:
“One or more intensivists are Present via telemedicine, in combination with on-site intensivist coverage, for a total of 24 hours per day, 7 days per week; meet all of Leapfrog’s ICU requirements for intensivist presence in the ICU via telemedicine; and supported by an on-site [physician] who establishes and revises the daily care plan for each ICU patient.”
Although throughput is unmentioned, one can see how the availability of additional nursing and intensive care physicians throughout all departments can solve many of the challenges standing in the way of efficient discharge.
In consultation with on-site team members, a tele-intensivist can make data-driven clinical decisions on whether a patient is ready to be discharged or requires additional intervention. He or she can review vitals and make an informed diagnosis before building the care plan necessary for patient transfer to another department or facility.
On the nursing side, tele-critical care nurses are a valuable resource to on-site care by providing continuous remote monitoring and expert guidance, which enhances the ability of bedside nurses to manage complex patient cases. Their collaboration with on-site staff ensures timely interventions and supports critical decision-making to expedite and facilitate patient throughput, ultimately improving patient outcomes and reducing the burden on local healthcare providers The presence of tele-critical care team members can significantly reduce the time spent in the highest acuity settings, freeing those beds up for new high-acuity patients and graduating the patients to an appropriate level of care.
Patient throughput ultimately hinges on two things: the availability of beds, and the availability of staff with the appropriate expertise. It’s the latter challenge proving to be among the thorniest issues to solve for hospitals. And while there are no one-size-fits-all solutions, tele-critical care, tele-nursing and creative digital staffing plans are proving to be among the most promising answers for many healthcare facilities.
To learn more about improving patient throughput at your facility through tele-critical care, tele-nursing and more, click here.
