ClinicalTrials.gg
Not yet recruitingNCT07768410Updated Aug 17, 2026

Supply Induced Demand in Intensive Care Unit: a Retrospective Trial

An observational study in Intensive Care (ICU), Intensive Care Unit (ICU) Admission and Intensive Care Unit Survivors, sponsored by Saint Camillus International University of Health Sciences. Not yet recruiting at 1 site in Italy. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-08-17.

Sponsored by Saint Camillus International University of Health Sciences · Observational

Study type
Observational
Model
Cohort
Time perspective
Retrospective
Enrollment
1,500
Ages
18 Years and older
Sex
All
01

Study summary

Intensive Care Unit (ICU) represents a high-level healthcare and expensive resource in hospitals. The causes of hospitalization in critical care are therefore multiple, and over the years numerous prognostic scores have been proposed, which therefore correlate the severity of the pathology with the predicted mortality from a statistical point of view. The function of the scores is also to assist the physician in clinical choices. The two most frequently used prognostic scores in critical care are the Acute Physiology And Chronic Health Evaluation (APACHE) II score and the Simplified Acute Physiology Score (SAPS) II.

The choice to admit a patient to Intensive Care, therefore, is a clinical, economic and managerial choice. Due to the costs of the ICU beds, as well as to the fact that shortage of beds may have a significant clinical impact on patients, many studies addressed the issue of supply-induced scarcity (SIS), i.e. scarcity due to a lack of supply and not to an excess of demand. On the other side, Health Economics has demonstrated that often an increase in supply can generate an increase in demand, even when this increase is not strictly necessary or appropriate. This phenomenon, called supply-induced demand (SID), to the best of our knowledge, few studies have been conducted in critical care settings; moreover, the correlation between SID and outcomes, specifically mortality, has never been demonstrated.

The aim of this retrospective, single-center study, therefore, is to investigate the presence of SID, and the consequent effects on mortality outcome, in a multispecialty Postoperative Intensive Care Unit.

Read the detailed description

Intensive Care Unit (ICU) represents a high-level healthcare resource in hospitals. An ICU bed is expensive compared to other types of beds, estimated at between €937 and €1,472 each, according to studies in several European countries. The ICU is the department where the hospital's most seriously ill patients are treated. The nature of the hospitalization can vary, and each hospital has the option of having a multispecialty ICU (dedicated to all critically ill patients), or alternatively dedicated ICUs based on the primary pathology, such as cardiac surgery, neurosurgery, post-operative intensive care, transplant surgery, etc.

The causes of hospitalization in critical care are therefore multiple, and over the years numerous prognostic scores have been proposed, which therefore correlate the severity of the pathology with the predicted mortality from a statistical point of view. The function of the scores is also to assist the physician in clinical choices, helping to select patients who are presumed to have the greatest chance of benefiting from hospitalization in an intensive care environment, and therefore discarding patients who are either not too serious, or vice versa too compromised to benefit from hospitalization of this type. The long and difficult stay in Intensive Care can also influence the turnover of beds, and their availability.

The two most frequently used prognostic scores in critical care are the Acute Physiology And Chronic Health Evaluation (APACHE) II score and the Simplified Acute Physiology Score (SAPS) II. Both widely used in clinical and scientific settings, these scores present some differences: while the SAPS II has a more streamlined framework of the patient's clinical characteristics, the APACHE II considers a little more the anamnesis and chronic pathologies of the subject hospitalized in Intensive Care. In fact, the vital and physiological parameters addressed with the APACHE II are numerically higher than those of the SAPS II. Despite this, there does not appear to be a difference between the two scores in terms of predictive value of mortality; some studies have examined this hypothesis, finding both systems reliable from this point of view.

The choice to admit a patient to Intensive Care, therefore, is a clinical, economic and managerial choice. In recent years, several studies have examined the availability of beds in Intensive Care and their impact on the clinical and economic performance of the department. Sometimes the turnover is technically and temporally expensive due to numerous reasons, such as the severity of the clinical picture, the high level of monitoring and the number of connected machines, delaying the patient's admission. Several studies have noted how the waiting time before admission to Intensive Care increases patient mortality, especially when it is longer than 6 hours.

Due to the costs of the ICU beds, as well as to the fact that shortage of beds may have a significant clinical impact on patients, many studies addressed the issue of supply-induced scarcity (SIS), i.e. scarcity due to a lack of supply and not to an excess of demand.

In the case of beds in Intensive Care, some authors have demonstrated how the phenomenon of SIS affects the critical environment, but without alterations in the perception of value; for example, although the economic cost of a bed of this type is higher than in other departments, the cost/benefit ratio in terms of perception of the service provided remains positive for the patient and for the community. From 2020 onwards, following the Covid-19 pandemic, we have witnessed a profound revolution in the availability, number and type of triage that underlie the availability of beds in Intensive Care.

On the other side, Health Economics has demonstrated that often an increase in supply can generate an increase in demand, even when this increase is not strictly necessary or appropriate. This phenomenon, called supply-induced demand (SID), to the best of our knowledge, few studies have been conducted in critical care settings; moreover, the correlation between SID and outcomes, specifically mortality, has never been demonstrated.

The aim of this retrospective, single-center study, therefore, is to investigate the presence of SID, and the consequent effects on mortality outcome, in a multispecialty Postoperative Intensive Care Unit.

02

Conditions studied

  • Intensive Care (ICU)
  • Intensive Care Unit (ICU) Admission
  • Intensive Care Unit Survivors
  • SID
  • Health and Social Services

Browse trials for

Keywords

  • Intensive Care Unit
  • ICU
  • Intensive Care Unit Admission
  • Supply Induced Demand
  • SID
03

In context

Sudden Infant Death

80 studies on the registry are indexed under Sudden Infant Death; 14 are open to participants now.

This study's planned enrollment of 1,500 is above the median of 100 across 26 observational studies indexed under Sudden Infant Death.

Browse Sudden Infant Death studies →

Lead sponsor

Saint Camillus International University of Health Sciences is the lead sponsor of 4 studies on the registry; 1 is open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Non-probability sample

Study population

Post-operative Intensive Care, St. Eugenio Hospital, Rome, Italy

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Patients admitted to the ICU from November 2018 to November 2025

Exclusion criteria

Exclusion Criteria:

  • Incomplete documentation
05

Study design

Observational model
Cohort
Time perspective
Retrospective
Enrollment
1,500 participants (estimated)
Patient registry
No

Groups and cohorts

  • Patients admitted to the post-operative intensive care unit
06

What researchers measure

Primary outcomes

  1. Presence of supply-induced demand for intensive care admission

    Assess the patient's severity (APACHE II and SAPS II prognostic scores) based on the number of available beds at the time of admission

    Time frame: At enrollment

Secondary outcomes

  1. Mortality

    Observe any potential correlation between SID and mortality incidence

    Time frame: From enrollment to the ICU discharge

07

Study locations

1 site
08

References and documents

Publications

  • Robert R, Coudroy R, Ragot S, Lesieur O, Runge I, Souday V, Desachy A, Gouello JP, Hira M, Hamrouni M, Reignier J. Influence of ICU-bed availability on ICU admission decisions. Ann Intensive Care. 2015 Dec;5(1):55. doi: 10.1186/s13613-015-0099-z. Epub 2015 Dec 30. PubMed 26714805 ↗
  • Fuchs L, Novack V, McLennan S, Celi LA, Baumfeld Y, Park S, Howell MD, Talmor DS. Trends in severity of illness on ICU admission and mortality among the elderly. PLoS One. 2014 Apr 3;9(4):e93234. doi: 10.1371/journal.pone.0093234. eCollection 2014. PubMed 24699251 ↗
  • Barbash IJ, Wallace DJ, Kahn JM. Effects of Changes in ICU Bed Supply on ICU Utilization. Med Care. 2019 Jul;57(7):544-550. doi: 10.1097/MLR.0000000000001137. PubMed 31107397 ↗
  • Gooch RA, Kahn JM. ICU bed supply, utilization, and health care spending: an example of demand elasticity. JAMA. 2014 Feb 12;311(6):567-8. doi: 10.1001/jama.2013.283800. No abstract available. PubMed 24408679 ↗
  • Edbrooke DL, Minelli C, Mills GH, Iapichino G, Pezzi A, Corbella D, Jacobs P, Lippert A, Wiis J, Pesenti A, Patroniti N, Pirracchio R, Payen D, Gurman G, Bakker J, Kesecioglu J, Hargreaves C, Cohen SL, Baras M, Artigas A, Sprung CL. Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis. Crit Care. 2011;15(1):R56. doi: 10.1186/cc10029. Epub 2011 Feb 9. PubMed 21306645 ↗
  • Riccioni L, Bertolini G, Giannini A, Vergano M, Gristina G, Livigni S, Mistraletti G, Petrini Gruppo di Lavoro Siaarti-Societa Italiana di Anestesia Analgesia Rianimazione E Terapia Intensiva F. [Clinical ethics recommendations for the allocation of intensive care treatments, in exceptional, resource-limited circumstances.]. Recenti Prog Med. 2020 Apr;111(4):207-211. doi: 10.1701/3347.33183. Italian. PubMed 32319442 ↗
  • Churpek MM, Wendlandt B, Zadravecz FJ, Adhikari R, Winslow C, Edelson DP. Association between intensive care unit transfer delay and hospital mortality: A multicenter investigation. J Hosp Med. 2016 Nov;11(11):757-762. doi: 10.1002/jhm.2630. Epub 2016 Jun 28. PubMed 27352032 ↗
  • Cardoso LT, Grion CM, Matsuo T, Anami EH, Kauss IA, Seko L, Bonametti AM. Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Crit Care. 2011;15(1):R28. doi: 10.1186/cc9975. Epub 2011 Jan 18. PubMed 21244671 ↗
  • Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP; DELAY-ED study group. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med. 2007 Jun;35(6):1477-83. doi: 10.1097/01.CCM.0000266585.74905.5A. PubMed 17440421 ↗
  • Mathews KS, Durst MS, Vargas-Torres C, Olson AD, Mazumdar M, Richardson LD. Effect of Emergency Department and ICU Occupancy on Admission Decisions and Outcomes for Critically Ill Patients. Crit Care Med. 2018 May;46(5):720-727. doi: 10.1097/CCM.0000000000002993. PubMed 29384780 ↗
  • Czajka S, Ziebinska K, Marczenko K, Posmyk B, Szczepanska AJ, Krzych LJ. Validation of APACHE II, APACHE III and SAPS II scores in in-hospital and one year mortality prediction in a mixed intensive care unit in Poland: a cohort study. BMC Anesthesiol. 2020 Dec 2;20(1):296. doi: 10.1186/s12871-020-01203-7. PubMed 33267777 ↗
  • Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993 Dec 22-29;270(24):2957-63. doi: 10.1001/jama.270.24.2957. PubMed 8254858 ↗
  • Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct;13(10):818-29. PubMed 3928249 ↗
  • Tan S, Martin J, Pezzi A, Bakker J, Neurohr C, Pitrelli A, Hakkaart L, Welte R. Microcosting study of ICU costs in three European countries. Crit Care 2008,12(Suppl 2):P526
  • Tan SS, Bakker J, Hoogendoorn ME, Kapila A, Martin J, Pezzi A, Pittoni G, Spronk PE, Welte R, Hakkaart-van Roijen L. Direct cost analysis of intensive care unit stay in four European countries: applying a standardized costing methodology. Value Health. 2012 Jan;15(1):81-6. doi: 10.1016/j.jval.2011.09.007. PubMed 22264975 ↗
  • Edbrooke DL, Ridley SA, Hibbert CL, Corcoran M. Variations in expenditure between adult general intensive care units in the UK. Anaesthesia. 2001 Mar;56(3):208-16. doi: 10.1046/j.1365-2044.2001.01716.x. PubMed 11251425 ↗

Individual participant data

Plan to share: No — There is no plan to share Individual Participant Data (IPD); however, anonymized data may be made available upon reasonable request, subject to sponsor approval and ethical considerations.

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Aug 17, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT07768410
Lead sponsor
Saint Camillus International University of Health Sciences
Responsible party
Diego Fiume (Principal Investigator, Saint Camillus International University of Health Sciences) — Principal investigator
First posted
Aug 17, 2026
Start date
Aug 20, 2026 (estimated)
Primary completion
Sep 20, 2026 (estimated)
Completion
Sep 20, 2026 (estimated)
Last update
Aug 17, 2026

Study contacts

Diego Fiume
Contact
diego.fiume@unicamillus.org
0039 0651002979
Diego Fiume
study chair · UniCamillus - Saint Camillus International University of Health and Medical Sciences

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is not yet recruiting, as verified in Aug 2026. You cannot join it, but the record below documents what was studied.

Follow this study

Get an email when the registry record changes — status, dates, results — or when someone posts here.

Sign in to follow

Discussion

Questions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.

Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.

Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.

Start the discussion