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Intensive Care (ICU)NCT07768410

Supply Induced Demand in Intensive Care Unit: a Retrospective Trial

An observational study of Intensive Care (ICU) and Intensive Care Unit (ICU) Admission, run by Saint Camillus International University of Health Sciences at 1 site in Italy.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial 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… Read more about this study

Who is it for?
Ages 18 years and older
How many people
1,500 participants
Where
1 siteItaly
Study dates
20 Aug 2026to 20 Sep 2026
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

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

Who may be able to join

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

Who cannot join

  • Incomplete documentation

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Italy1 site
  • St. Eugenio Hospital

    Rome, 00144

    Diego Fiume, 0039 0651002979, diego.fiume@unicamillus.org

    Massimo Galletti, 0039 0651002979, massimo.galletti@aslroma2.it

Other trials in Italy

About this study

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.

Keywords
Intensive Care Unit, ICU, Intensive Care Unit Admission, Supply Induced Demand, SID
Medical subject headings
Sudden Infant Death

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT07768410
Study groupRoleWhat they receive
Patients admitted to the post-operative intensive care unitNot described

What is being measured

The primary outcome is the main question the study is designed to answer.

  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

    Measured: At enrollment

Secondary outcomes (1)
  1. Mortality

    Observe any potential correlation between SID and mortality incidence

    Measured: From enrollment to the ICU discharge

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Aug 2026
  2. Study start20 Aug 2026 (estimated)
  3. Primary completion20 Sep 2026 (estimated)
  4. Study completion20 Sep 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Retrospective
Enrolment
1,500 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07768410
Sponsor's protocol ID
115.26
Status last verified
Aug 2026
First submitted
10 Aug 2026
Last updated
17 Aug 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
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.

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

Questions about this trial

What is this clinical trial studying?

An observational study of Intensive Care (ICU) and Intensive Care Unit (ICU) Admission, run by Saint Camillus International University of Health Sciences at 1 site in Italy.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 17 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Diego Fiume (0039 0651002979, diego.fiume@unicamillus.org), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Presence of supply-induced demand for intensive care admission (time frame: At enrollment). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07768410, which also lists 16 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Aug 2026.

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