title: Difficulties in access and estimates of public beds in intensive care units in the state of Rio de Janeiro.
abstract: OBJECTIVE
  To estimate the required number of public beds for adults in intensive care units in the state of Rio de Janeiro to meet the existing demand and compare results with recommendations by the Brazilian Ministry of Health.
  
  
  METHODS
  The study uses a hybrid model combining time series and queuing theory to predict the demand and estimate the number of required beds. Four patient flow scenarios were considered according to bed requests, percentage of abandonments and average length of stay in intensive care unit beds. The results were plotted against Ministry of Health parameters. Data were obtained from the State Regulation Center from 2010 to 2011.
  
  
  RESULTS
  There were 33,101 medical requests for 268 regulated intensive care unit beds in Rio de Janeiro. With an average length of stay in regulated ICUs of 11.3 days, there would be a need for 595 active beds to ensure system stability and 628 beds to ensure a maximum waiting time of six hours. Deducting current abandonment rates due to clinical improvement (25.8%), these figures fall to 441 and 417. With an average length of stay of 6.5 days, the number of required beds would be 342 and 366, respectively; deducting abandonment rates, 254 and 275. The Brazilian Ministry of Health establishes a parameter of 118 to 353 beds. Although the number of regulated beds is within the recommended range, an increase in beds of 122.0% is required to guarantee system stability and of 134.0% for a maximum waiting time of six hours.
  
  
  CONCLUSIONS
  Adequate bed estimation must consider reasons for limited timely access and patient flow management in a scenario that associates prioritization of requests with the lowest average length of stay.
authors.affiliation: Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Rosane Sonia
authors.initials: RS
authors.lastname: Goldwasser
authors.affiliation: Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Maria Stella de Castro
authors.initials: MS
authors.lastname: Lobo
authors.affiliation: Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Edilson Fernandes
authors.initials: EF
authors.lastname: de Arruda
authors.affiliation: Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Simone Aldrey
authors.initials: SA
authors.lastname: Angelo
authors.affiliation: Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: José Roberto
authors.initials: JR
authors.lastname: Lapa e Silva
authors.affiliation: Departamento de Engenharia Industrial, Escola Politécnica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: André Assis
authors.initials: AA
authors.lastname: de Salles
authors.affiliation: Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Cid Marcos
authors.initials: CM
authors.lastname: David
mesh_terms: D000328:Adult; D000368:Aged; D001509:Bed Occupancy / Q000706:statistics & numerical data*; D001938:Brazil; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000600:supply & distribution*; D007902:Length of Stay / Q000706:statistics & numerical data*; D009313:National Health Programs; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014505:Urban Population