Weekend Update: Hospital Bed Capacity, Staffing and Why We Are In Crisis
By Jeffrey Softcheck, MBA and Vineet Arora, MD, MAPP
Recently, there was a lot of interest in our statement that ICU beds would run out by Thanksgiving if nothing happened. We got your attention, and things started to happen but we are still in trouble.
The first thing that happened is the number of non-COVID ICU patients started to decline as the number of ICU COVID patients went up. Why? Well, we are hearing that hospitals are working to preserve ICU capacity given the rising numbers of COVID patients. Clinicians on the ground are reporting the need to carefully ration who gets an ICU bed given more COVID patients are coming. As a result, non-COVID patients who may have otherwise received ICU care are likely being managed outside of the ICU. Non-COVID ICU patients are also being discharged out of the ICU faster to make room. In addition, health systems started cancelling “elective” but medically necessary surgeries in an attempt to decrease ICU demand. The most morbid suggestion: more patients are dying in the hospital or at home because they are not coming in. This is why we do want to stress the importance of coming to the hospital if you are seriously ill. The fact that we have to say this underscores that the crisis has started.
Something else is happening that is very worrisome. As we have discussed before, bed capacity is not just about space for beds, rather it is about staff and supplies too. The most critical part of this equation is staffing, and as numerous reports across the Midwest and Illinois show, hospitals are struggling to staff their beds. As a result of this problem, IDPH recently changed the way they ask hospitals to report their number of beds to get a better picture of the immediate bed capacity available in our state. Instead of asking hospitals to report the number of beds they could theoretically open using makeshift spaces, hospitals are now asked to report the number of beds they can open immediately (within 4 hours). This is important because if you or your loved one has a heart attack or a stroke, you need a staffed bed immediately, not a theoretical bed. So what did we see with this change?
“We actually need to know how many beds are available that have staff that could actually work it,” Dr. Ezike said. “When you put that extra clause, that actually you would have the staff to man that bed now, the numbers drop significantly. It’s how many can you staff today.”
The number of staffed total beds fell by 2,499. Why? Simply put, we do not have the staff for the hospital beds anymore. Clinicians across the state are reporting units with that beds are empty because they lack staff. Why is staffing the problem? Well, staff are members of the community too and do not live in a bubble. When circulating virus rates are high, they get sick. They also get exposed and have to quarantine. They have to take care of sick family members and loved ones. The remaining ones left are pushed to the point of exhaustion and are being asked to work double shifts just to stay afloat. What does this mean? Well, when you look at bed capacity after adjusting for staffing, we are still getting dangerously close to reaching the critical 10% threshold of ICU beds, with many regions reporting less than 20% now. This will get worse because COVID hospitalizations are still increasing and our staff are still at risk with high rates of circulating virus. Couple that with Thanksgiving travel and the risk of superspreader events in families with vulnerable parents and grandparents, and we are all in trouble.
It is not too late to rethink your plans. After all, you are our only hope.