A recent report in Critical Care demonstrates the types

of steps hospitals are taking to address the growing problem of ICU capacity constraints [1]. Th ese steps are often necessary, as ICU strain leads to serious, real-world problems. For example, both admission delays from the emergency department to the ICU and premature discharges from the ICU to the ward are associated with increased mortality [2,3]. Moreover, although the data are mixed, new evidence suggests that when ICUs are strained, patients in the ICU experience a greater risk of death [4]. Full ICUs can also aff ect a hospital’s bottom line. Cancelling high-risk elective surgeries due to a lack of appropriate post operative care means less revenue at a time when many hospitals are struggling fi nancially [5]. Clearly the stakes are high. When faced with ICU capacity constraints, however, hospitals have a limite