Case Study – United General Hospital ICU Expansion Case Study
United General Hospital is a 15-year-old, 220-bed hospital built to serve a suburban community of
90,000 residents, 60 miles outside Des Moines, Iowa. Of the beds, 10 are in the intensive care unit (ICU).
Over the last 15 years, the community has grown to over 190,000 residents, who are supported by
United General and four urgent care facilities. With the urgent care facilities able to address many of the
population’s non-emergency issues, there is an increase in the ratio between the use of the hospital’s
non-ICU facilities and its ICU facilities. In a typical week, the ICU operates at 120% capacity and 40% of
patients experience a six- to eight-hour delay transferring to the ICU. The patients remain either in the
emergency department, creating an overcrowded emergency department, or in post-op, causing
overcrowding and delays in scheduled surgeries.
The hospital has just received $15 million in funding and is considering expanding the ICU; however, the
CEO is not convinced that expanding the ICU department is the right solution for the hospital. The
analysis is to include options that combine expanding the ICU department with using remote ICU
The ICU senior staff brought you, Raul Hemply, in as a consultant to build a business case to support the
decision to expand the ICU and use remote ICU monitoring. You will work with the ICU’s senior staff to
build a business case and present it to the CEO and board of directors for final consideration. There will
be great emphasis placed on data and analyses that support your recommendation. Because of this, you
need to use data derived from informed or objective sources, or evidence-based data, to build the
recommendation. The CEO will want to know the sources, validity, and reliability of the evidence
As you create your business case, there are several options to consider:
- Subscribe to remote ICU monitoring services with a per-usage model so that you only pay for
services as they are rendered.
- Expand the ICU with a combination of ICU beds and regular beds managed by a combination of
bedside and remote ICU monitoring.
- Expand the ICU with ICU rooms managed by bedside teams.
- Expand the ICU and subscribe to remote ICU monitoring for rooms that will serve patients with
more serious conditions.
2014 Walden University OM008
Excerpts of a conversation with George Mallory, the senior staff representative
George: Hello, Raul; it is good to meet you. We are looking forward to working with you on this business
case to expand the ICU. We have already completed some research on the right side of the ICU, and we
will share that with you over the course of your investigation.
Raul: Hi George, I appreciate you taking the time for this interview. This will help me in my research of
how much to expand the ICU; I am also considering the use of remote ICU monitoring service as a
complement to expanding the ICU.
George: Remote ICU monitoring services is a topic that will cause a lot of consternation here at United
General. We have a number of staff members who fear that a remote service will put them out of a job,
so I would touch lightly on that subject.
Raul: Has your group done any research on remote ICU monitoring services in the area?
George: We started to but realized that it was so controversial that it was not really an option. If you do
look into a remote service, please make sure to take the staff into account in the analysis.
Raul: What caused the controversy with the idea of remote ICU monitoring?
George: Physicians were reluctant to cede authority to a remote operation, and nurses were concerned
about a loss of autonomy. During a staff meeting, a couple of nurses voiced concerns because their
colleagues complained of a poorly executed implementation.
Raul: Thank you, George, I will. Can you tell me who on your staff has the research on the remote ICU
George: That would be Frank. Frank looked at the services from the standpoint of patient and staff
benefits and cost savings, as well as how the services help the patient. We suggested that he speak to
staff in hospitals that have implemented these services to get their reaction to the change, but he never
went through with that because the staff here was so set against it. It will be a hard sell to the staff.
Raul: Thank you for the heads up. Was there any other research completed about expanding the ICU
that I may be able to use?
George: I cannot think of anything else. You may want to check with other hospitals that use these
services, as part of your study.
Raul: Thank you, George; I think I have enough to get started. I will check back with you if I need any