Houston, we have a problem - Printable Version
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Houston, we have a problem - fullmetal - 07-10-2020
I'm starting to wonder about the TMC data being published -- are all those beds immediately available, or are they scheduled to be brought online in the near future but not currently available? As mentioned before, I think there is a lot of political pressure on hospital administrators to soft pedal their publicly available data. The stories from the trenches can't all be wrong, can they?
https://www.nbcnews.com/news/us-news/all-hospitals-are-full-houston-overwhelmed-icus-leave-covid-19-n1233430
(Also, it's possible that the very worst hit hospitals in Houston are not part of the TMC. When multiple ERs are diverting, however...)
RE: Houston, we have a problem - M T - 07-10-2020
The data is about acute & ICU beds. What this news article is about is the ER itself and the rate of incoming patients.
I'll see if I can find out about that.
As best I can tell, HCA (24 ERs but 4 closed) is not member of Texas Medical Center but has a hospital at TMC. Memorial Hermann is a member, but it has hospitals across the greater Houston area (19 ERs). [There are a number of other hospitals & ERs. Those are the two mentioned in the article. In addition, Houston has a number of trauma centers at different levels.]
At 5:15PM CST, Friday afternoon, HCA indicated the longest wait time of 11 of its ERs in the Houston metropolitan area was 9 minutes. 4 ERs are temporally closed (to consolidate resources), and another 9 didn't list any wait time (whether 0 or not, I don't know), including the one at TMC.
On a nothing-special day a year and a half ago, I went to the ER with pneumonia. It took about 6 hours (8PM to 2AM) to get a bed in a particular SCC hospital. Thankfully, they weren't busy.
RE: Houston, we have a problem - fullmetal - 07-10-2020
The data in the ER speaks to the lack of ICU capacity to receive patients admitted from the ER to the ICU. If there are a ton of ER patients, it's usually because there's not enough ICU staff or bed capacity to receive those patients. There are definitely staffing issues at play that aren't reflected in the TMC public data (which only talks about bed capacity).
Specifically, the title of the article is: "'All the hospitals are full': In Houston, overwhelmed ICUs leave COVID-19 patients waiting in ER."
Quote:Houston hospitals have been forced to treat hundreds of COVID-19 patients in their emergency rooms — sometimes for several hours or multiple days — as they scramble to open additional intensive care beds for the wave of seriously ill people streaming through their doors, according to internal numbers shared with NBC News and ProPublica.
Quote:“Normally that patient would just go to an ICU bed, but because there are no beds available, they continue to board in the emergency room,” said Harris Health System president and CEO Esmaeil Porsa, who oversees the city’s two public safety-net hospitals. “It is not an optimal level of care. This is not something we would choose to do. The only reason this is happening is because we are being forced to do it.”
Quote:Dr. Jamie McCarthy, an executive vice president at Memorial Hermann Health System and an emergency room physician, acknowledged that the coronavirus crisis has forced his teams to hold more patients in ERs.
“All the hospitals are full,” McCarthy said. “All the hospitals in the city are boarding patients. We are expanding capacity, but we can’t turn those on immediately. It requires staffing. It requires nurses and doctors to come in. And so, as we’ve continued to expand our inpatient capacity, we’re just keeping up with the volume that’s coming in.”
Quote:While Houston’s top hospital executives have repeatedly said they can add hundreds of new intensive care beds to meet the demand, at least for the next couple of weeks, the number of patients being treated in emergency rooms demonstrates the difficulty of executing those plans in the midst of a rapidly growing crisis, officials say.
“Those things are not like a switch-key type of activity,” said Porsa, the Harris Health System CEO, noting that his hospitals have had to send patients to hospitals outside of Houston to make room. “The bottleneck to do that is really staffing. As you can imagine, ICU nurses are not a dime a dozen. They are very hard to come by, and it takes time to actually be able to do that.”
RE: Houston, we have a problem - teejers1 - 07-10-2020
(07-10-2020, 03:00 PM)fullmetal Wrote: I'm starting to wonder about the TMC data being published -- are all those beds immediately available, or are they scheduled to be brought online in the near future but not currently available? As mentioned before, I think there is a lot of political pressure on hospital administrators to soft pedal their publicly available data. The stories from the trenches can't all be wrong, can they?
https://www.nbcnews.com/news/us-news/all-hospitals-are-full-houston-overwhelmed-icus-leave-covid-19-n1233430
(Also, it's possible that the very worst hit hospitals in Houston are not part of the TMC. When multiple ERs are diverting, however...)
First, I view it as a positive that news outlets are reporting more on hospitals and workers there. Very important.
Second, when reading the articles, I suggest doing so carefully, looking for info on total beds (regular and ICU), breakdown of usage by Covid/non-Covid, and ideally some historical context on whether non-Covid numbers are below historical figures (which I still suspect would be the case . . . but it would be good to have confirmation on that). Then you'd also like to know what emergency or surge capacity is available, if any, and timeline for implementing same.
I've lamented here a few times already that the SCC dashboard - which used to report on hospital capacity and breakdown by Covid/non-Covid - has stopped doing that. But I just looked at the board today, and there was something on the page reporting deaths that caught my eye:
"Deaths provided in this dashboard do not necessarily mean that the individuals died from COVID-19."
What does that mean? Does it mean that the decedent was suffering from Covid at time of death but may have died from other causes? Or does it mean something else? Any edification appreciated (and apologies if this was previously explained but I missed it).
RE: Houston, we have a problem - akiddoc - 07-11-2020
(07-10-2020, 03:27 PM)M T Wrote: The data is about acute & ICU beds. What this news article is about is the ER itself and the rate of incoming patients.
I'll see if I can find out about that.
As best I can tell, HCA (24 ERs but 4 closed) is not member of Texas Medical Center but has a hospital at TMC. Memorial Hermann is a member, but it has hospitals across the greater Houston area (19 ERs). [There are a number of other hospitals & ERs. Those are the two mentioned in the article. In addition, Houston has a number of trauma centers at different levels.]
At 5:15PM CST, Friday afternoon, HCA indicated the longest wait time of 11 of its ERs in the Houston metropolitan area was 9 minutes. 4 ERs are temporally closed (to consolidate resources), and another 9 didn't list any wait time (whether 0 or not, I don't know), including the one at TMC.
On a nothing-special day a year and a half ago, I went to the ER with pneumonia. It took about 6 hours (8PM to 2AM) to get a bed in a particular SCC hospital. Thankfully, they weren't busy.
Time to get into a hospital bed usually has more to do with nursing availability than census. Hospitals try to run lean to save money. Normally you have to wait for the next nursing shift when they call in extra nurses to get out of the ER and into a bed.
RE: Houston, we have a problem - M T - 07-11-2020
(07-10-2020, 11:11 PM)teejers1 Wrote: But I just looked at the board today, and there was something on the page reporting deaths that caught my eye:
"Deaths provided in this dashboard do not necessarily mean that the individuals died from COVID-19."
What does that mean? Does it mean that the decedent was suffering from Covid at time of death but may have died from other causes? Or does it mean something else? Any edification appreciated (and apologies if this was previously explained but I missed it).
The official cause of death from the autopsy of the (delayed) first known COVID-19 related death in SCC was
"Acute Hemopericardium due to ... due to ... with ... due to COVID-19 Infection"
So, yes, I believe that means if the decedent had COVID-19 and dies from anything (car accident, heart attack, suicide, ..), they will be counted.
Probably, somewhere is an official explanation but I don't recall seeing it. (FAQ, maybe)
The inclusive/exclusive counting of deaths has been discussed as to a reason it is problematic to compare death stats from different countries.
RE: Houston, we have a problem - M T - 07-11-2020
(07-11-2020, 03:30 AM)akiddoc Wrote: Time to get into a hospital bed usually has more to do with nursing availability than census. Hospitals try to run lean to save money. Normally you have to wait for the next nursing shift when they call in extra nurses to get out of the ER and into a bed.
I take that to mean that if ER beds are occupied waiting for hospital beds, the ER nurses covering those beds are still assigned to them, so they aren't available to take a patient waiting in an ambulance for a ER nurse to be assigned (which at least one of the articles was saying that was taking up to an hour). Then, since that ambulance is busy, their response time is impacted. [I do presume that a triage happens, so a trauma victim (or other patient in immediate distress) gets help immediately.]
The Texas Hospital Association lists 81 hospitals in Harris County (of which Houston is the majority of that area). The Greater Houston area encompasses 9 counties. The Houston Chronicle gave the bed counts of the larger hospitals in the area in 2013. (The Wikipedia page on Houston hospitals is scatter-brained, so don't bother with it (yet).)
The Texas governor mandated that elective surgeries had to be cease in Harris County (I think that was this past Tuesday.)
The Texas governor said that if mask usage doesn't improve and cases continue to spike, he may have to shut the state down again. He indicated that would be a last resort.
RE: Houston, we have a problem - fullmetal - 07-11-2020
Agreed. This is one of the reasons why I was never comforted by the TMC hospital CEO joint statement claiming that there were sufficient beds. Bed count is...a nice red herring, especially when you have plans for more beds yet either haven't equipped the beds (converted from med surg) or haven't executed staffing plans for the new beds.
RE: Houston, we have a problem - akiddoc - 07-11-2020
(07-11-2020, 02:16 PM)M T Wrote:(07-11-2020, 03:30 AM)akiddoc Wrote: Time to get into a hospital bed usually has more to do with nursing availability than census. Hospitals try to run lean to save money. Normally you have to wait for the next nursing shift when they call in extra nurses to get out of the ER and into a bed.
I take that to mean that if ER beds are occupied waiting for hospital beds, the ER nurses covering those beds are still assigned to them, so they aren't available to take a patient waiting in an ambulance for a ER nurse to be assigned (which at least one of the articles was saying that was taking up to an hour). Then, since that ambulance is busy, their response time is impacted. [I do presume that a triage happens, so a trauma victim (or other patient in immediate distress) gets help immediately.]
The Texas Hospital Association lists 81 hospitals in Harris County (of which Houston is the majority of that area). The Greater Houston area encompasses 9 counties. The Houston Chronicle gave the bed counts of the larger hospitals in the area in 2013. (The Wikipedia page on Houston hospitals is scatter-brained, so don't bother with it (yet).)
The Texas governor mandated that elective surgeries had to be cease in Harris County (I think that was this past Tuesday.)
The Texas governor said that if mask usage doesn't improve and cases continue to spike, he may have to shut the state down again. He indicated that would be a last resort.
If you are sitting in an ER awaiting a hospital bed because you are being admitted, and the hospital is not at capacity, your long wait is due to the way nurses are scheduled to work up on the medical and surgical floors.
RE: Houston, we have a problem - M T - 07-21-2020
Just giving an update on the situation in Houston, or at least for the Texas Medical Center.
Good news: The number of hospitalizations flattened out and is slightly off the peak (new hospitalizations started to drop 2 weeks ago; beds in use started to drop a week ago).
Bad news: The % positive rates are still quite high (>20%) and generally rising. The % positive rate is falling (peaked at 23%, down to 20%) in testing at the hospitals, but for the Greater Houston area, the % positive rate has spiked from 12% 9 days ago to 25% now (while # of tests has decreased).