Robustness of Proactive Intensive Care Unit Transfer Policies

Abstract

Patients whose transfer to the intensive care unit (ICU) is unplanned are prone to higher mortality rates. In “Robustness of Proactive Intensive Care Unit Transfer Policies,” the authors study the problem of finding robust patient transfer policies to the ICU, which account for uncertainty in statistical estimates because of data limitations when optimizing to improve overall patient care. Under general assumptions, it is shown that an optimal transfer policy has a threshold structure. A robust policy also has a threshold structure, and it is more aggressive in transferring patients than the optimal nominal policy, which does not consider parameter uncertainty. The sensitivity of various hospital metrics to small changes in the parameters is highlighted using a data set of close to 300,000 hospitalizations at 21 Kaiser Permanente Northern California hospitals. This work provides useful insights into the impact of parameter uncertainty on deriving simple policies for proactive ICU transfer that have strong empirical performance and theoretical guarantees.