Assessing the Impact of Service Intensity on Customers : An Empirical Investigation of Hospital Step-Down Units

Servers with different skill sets which can serve multiple c ustomer classes are prevalent in many different service set tings. Much of the literature studying such systems relies o n an understanding of the relative costs and benefits associa ted with serving each customer type by these flexible servers. In this work, we focus on estimating these costs and benefits in a complex healthcare setting where the major differentia tion among server types is the intensity of service provided . Step Down Units (SDUs) were initially introduced in hospita ls to provide an intermediate level of care for semi-critica lly ill patients who are not sick enough to require intensive car e but not stable enough to be treated in the general medical/surgical ward. Using data from 10 hospitals from a singl e hospital network, we empirically estimate the costs and benefits associated with routing patients to the SDU. Our emp irical findings suggest that SDU care is associated with better clinical outcomes (reductions in mortality, readmissi on , and hospital length-of-stay) for some patients. Howev er, we find evidence that inappropriately admitting patients to th e SDU who should be treated in the Intensive Care Unit (ICU) is associated with increased mortality risk and hospital LO S. ur findings suggest that an SDU may be a cost-effective way to treat patients when used for patients who are post-ICU . However, the impact of SDU care is more nuanced for patients admitted from the emergency department (ED) and ou r res lts imply that more study is needed when using SDU care this way.