Introduction: A tertiary care hospital has experienced increasing level of patient acuity, high census levels, and high volume elective Operating Room schedules leading to patient flow difficulties. This culminated in significant elective OR delays in 1997 and high levels of non-availability of critical care beds for trauma and transfer utilization. To address this the hospital instituted a multidisciplinary approach to the management of surgical bed triage and patient flow in early 1998. Representatives from the Operating Room, Post Anesthetic Care Unit (PACU), SICU, Bed Control, and Step-Down floors meet each day to triage patients and optimize resource utilization. Finally, the Critical Care Attending has been in-house and has had ultimate responsibility for triage since July 1, 1998. Critical Care resource utilization was analyzed via tracking of time that the Life Flight referral was required to divert critically ill and trauma patients. Methods: The number of minutes each month that the Life Flight referral network was required to divert critically ill patients from DUMC was reviewed. Results: Total minutes of diversion for 1997 was 60,925, whereas total diversion for 1998 was 20,670 minutes. In addition, since the institution of in-house attending in charge of surgical critical care bed triage, there has been a total of 1130 minutes of diversion. This is compared with 20,800 minutes from the same period in 1997. Conclusions: The combination of predictable and streamlined resource utilization with 24 hour in-house attending responsibility for surgical critical care bed triage has dramatically improved resource utilization, as documented by significantly decreased time the critical care helicopter referral system has been on diversion. The pressures of high-patient acuity, high census levels, and wide referral patterns require hospital-wide coordination and direct 24-hour attending-level responsibility for bed triage in order to manage resources in optimal fashion.