Staffing decisions in a tele-ICU: dedicated versus flexible resources

Abstract

In a tele-ICU center with flexible staff scheduling, interruptions to tasks with lower priority are common, often prolonging the processing time of these tasks. Dedicated staff scheduling, however, can reduce such interruptions. While dedicated staff scheduling is generally perceived to be less efficient than flexible systems according to traditional queueing theory, the reductions in interruptions call this result into question. To investigate when dedicated staff scheduling could be more efficient than flexible systems for tele-ICUs, we build a discrete-event simulation model to analyze the operational process of admissions and interventions at a real tele-ICU center. Our simulation results show that if the dedicated nurse (intensivist) can process admissions at least 31% (26%) faster than the flexible nurse (intensivist), the dedicated staff scheduling will be preferred. Thus, the tele-ICU administrators should choose the scheduling approach (flexible versus dedicated) based on how often interruptions are likely to occur and their anticipated effect on prolonging the medical staff’s processing times of the interrupted tasks. Our simulation model can also help tele-ICU administrators determine a suitable staffing level by providing the estimated waiting times of admissions and interventions under varying staffing levels.