Identifying "Waste" in the ICU

​Memorial Hermann/University of Texas Health Science Center at Houston

Houston, Texas, USA


  • Khalid F. Almoosa, MD, MS, Assistant Professor of Medicine, University of Texas Health Science Center, Houston
  • Bela Patel, MD, FCCP, Assistant Chief Medical Officer and Executive Medical Director of Critical Care Medicine, Memorial Hermann Hospital  Texas Medical Center
  • Katharine Luther, RN, MPM, Vice President, Institute for Healthcare Improvement



This project storyboard was presented at the Society for Critical Care Medicine Annual Congress in Houston, Texas, in February 2012.



We sought to determine the prevalence of and reasons for inappropriate use of ICU beds, as one component of “waste,” using the Hospital Inpatient Waste Identification Tool developed by the Institute for Healthcare Improvement. We specifically identified the proportion of ICU beds that are inappropriately utilized and potentially contribute to “wasted” resources.


Below is a synopsis of the work. View the complete storyboard.


We determined the extent of and reasons for inappropriate use of hospital ICU beds using the IHI’s Hospital Inpatient Waste Identification Tool. We asked the ICU attending physicians on clinical service at both a 16-bed “closed” medical ICU (MICU) and a 10-bed “open” transplant surgical ICU (TSICU) to review daily all patients’ criteria for remaining in the ICU. For patients who did not meet ICU criteria and were not being transferred out (i.e., inappropriate ICU stay), the attending physicians identified the reason(s) and recorded them using the Waste Identification Tool.


Over a 3-month period (85 days), 583 patients (396 in MICU and 187 in TSICU) were admitted to both ICUs, for a total of 1,631 patient-days.

  • Physicians determined that 15 percent of MICU patient-days and 26 percent of TSICU patient-days were “waste.”
  • The main reasons for the wasted days in both ICUs were delays in end-of-life decision-making and transfers out of the ICU (i.e., awaiting beds).
  • Determination of “waste” also varied among the 7 attending physicians who participated in this study and may reflect the subjective use of this tool.





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