Critical care capacity: planning for future resources
Our 2024 Data on the Edge report “Critical Care Capacity: Balancing Medical and Surgical” highlighted the widening gap between rising critical care demand and constrained intensive care unit (ICU) bed availability across all hospitals. As demand and acuity continue to increase, understanding critical care patient mix remains essential. Equally important is a deliberate assessment of ICU bed capacity to ensure hospitals are prepared to meet future needs with the right level of care, at the right place and at the right time.
Critical care patient days and acuity are on the rise
ICU days are projected to increase by 14% between 2025 and 2035, compared to just 5% growth in overall inpatient utilization during the same period. As shown in Figure 1, medical ICU days continue to represent the majority of critical care demand, accounting for 57% of critical care use in 2025, driven primarily by mediumand high-acuity cases. Looking ahead, the demand for medical ICU days is projected to grow by 14% through 2035, outpacing the 12% increase forecasted for surgical cases. This widening imbalance will intensify pressure on ICU capacity constraints, particularly in hospitals already operating near their limits. Notably, surgical growth is concentrated in the most resource-intensive categories (i.e., tertiary and quaternary), which will increase the need for ICU resources.
These trends underscore the importance of a more proactive approach to ICU planning—one that integrates acuity-based forecasting, patient mix optimization and a broad hospital access strategy. Without a shift in how systems plan for and distribute ICU beds, the strain on critical care infrastructure will only worsen, particularly in areas where ICU bed closures or staffing shortages are already limiting access.
A closer look at ICU utilization
The ALOS for critical care patients has risen significantly since 2019, with the sharpest increases observed in community hospitals (see Figure 2). This trend reflects growing patient complexity and persistent throughput challenges. At the same time, ICU occupancy rates have remained consistently high across both AMCs and community hospitals, leaving little flexibility to absorb future demand.
As recently highlighted in JAMA Network Open, national hospital occupancy has risen to an average of 75% and may surpass 85% by 2032. Access bottlenecks in other parts of the hospital create the risk of filling ICU beds with low- and medium-acuity patients. Active management of the ICU patient mix is more critical than ever to preserve high-acuity capacity and maintain quality of care. For hospitals already experiencing strain from recent growth, identifying solutions to improve ICU access and efficiency will be essential to meet rising critical care needs.
Building toward an ICU bed need assessment
A foundational approach to estimating ICU bed need begins with analyzing the hospital’s total ICU days by DRG, then projecting future utilization based on demand trends. By combining these ICU day estimates with an appropriate target occupancy rate, organizations can produce a high-level forecast of ICU bed requirements over time.
To illustrate this methodology, Vizient integrated its Clinical Data Base with the Sg2 Impact of Change® forecast to generate a national ICU utilization calculation. Current ICU volumes and patient days were projected over the next decade. Table 1 highlights the 10 DRGs that account for the largest share of ICU days in 2025, along with their ALOS and projected growth rates through 2035.
These 10 DRGs account for 37% of total ICU days nationally; no single DRG has more than a 10% share. They represent a diverse mix of medical and surgical cases, spanning tertiary, high- and medium-acuity levels. Notably, most are projected to experience double-digit growth in ICU days over the next decade. Hospitals can customize and expand this analysis using their own data to support ICU bed forecasting and inform targeted critical care planning strategies. This approach also supports hospitals in leveraging internal data for more granular predictive analytics. Identifying patterns, such as seasonal surges (e.g., flu season) or weekday fluctuations driven by elective surgeries, allows hospitals to anticipate capacity constraints and proactively plan for staffing, bed availability and care pathways to improve critical care access.
Justin Cassidy, PhD
To speak with one of our experts about critical care strategy, contact membercenter@sg2.com.
Why it matters
- Patient mix influences ICU sustainability. Low- and medium-acuity medical cases comprise approximately 40% of total ICU days. As patient acuity is projected to increase over the next decade, hospitals must align not only the volume but also the type of ICU capacity with future demand. Ensuring ICU resources are reserved for patients who truly require high-acuity care is essential.
- Longer stays and high occupancy are the new norm. ICU length of stay has been rising, particularly in community hospitals. With occupancy rates persistently high, proactive ICU bed planning is essential to prevent capacity strain and preserve care access.
- Analytics enable proactive ICU planning. DRG-level projections of ICU days, combined with occupancy assumptions, enable organizations to rightsize ICU resources more accurately. By factoring in patient acuity, planning can address not only how much capacity is needed but also what level of care is required.
- Intermediate care expands options without full ICU costs. Hospitals should evaluate the role of intermediate or step-down units as these units can safely manage medium-acuity patients, reduce ICU overutilization and optimize patient placement across the continuum of care.
- Workforce strategy is critical to ICU sustainability. To address ongoing workforce challenges, hospitals should explore tech-enabled care models that leverage digital tools and AI-driven solutions to augment clinical workflows and expand critical care capacity.
- Triage and command centers optimize critical care flow. Proactive triage, both into and out of the ICU, is vital for maintaining bed availability. Centralized command centers, supported by AI-enabled analytics, can help predict which patients are likely to require intensive care and guide real-time decisions on admissions, transfers and discharges.