BACKGROUND: Neurosciences intensive care units (NICUs) provide institutional centers for specialized care. Despite a demonstrable reduction in morbidity and mortality, NICUs may experience significant capacity strain with resulting supraoptimal utilization and diseconomies of scale. We present an implementation study in the recognition and management of capacity strain within a large NICU in the United States. Excessive resource demand in an NICU creates significant operational issues. OBJECTIVE: To evaluate the efficacy of a Reserved Bed Pilot Program (RBPP), implemented to maximize economies of scale, to reduce transfer declines due to lack of capacity, and to increase transfer volume for the neurosciences service-line. METHODS: Key performance indicators (KPIs) were created to evaluate RBPP efficacy with respect to primary (strategic) objectives. Operational KPIs were established to evaluate changes in operational throughput for the neurosciences and other service-lines. For each KPI, pilot-period data were compared to the previous fiscal year. RESULTS: RBPP implementation resulted in a significant increase in accepted transfer volume to the neurosciences service-line (P =. 02). Transfer declines due to capacity decreased significantly (P =. 01). Unit utilization significantly improved across service-line units relative to theoretical optima (P <. 03). Care regionalization was achieved through a significant reduction in "off-service" patient placement (P =. 01). Negative externalities were minimized, with no significant negative impact in the operational KPIs of other evaluated service-lines (P =. 11). CONCLUSION: Capacity strain is a significant issue for hospital units. Reducing capacity strain can increase unit efficiency, improve resource utilization, and augment service-line throughput. RBPP implementation resulted in a significant improvement in service-line operations, regional access to care, and resource efficiency, with minimal externalities at the institutional level.