SCC updating/correcting bed availability

[M T]

In another post, I noted a sharp drop in total number of total hospital beds from the week before Thanksgiving to Thanksgiving week.  (I hypothesized this might be due to staff vacations, but that was apparently wrong.)  Now, their numbers show the lower numbers further back.

At their website, SCC notes

We are in the process of correcting historical data for bed availability in both the ICU and non-ICU. Some hospitals had their surge beds included in these counts, while only non-surge beds are meant to be reflected. The most recent counts of available beds will be lower than they previously appeared, showing a recent decline in the availability of non-surge hospital beds. This is due to the removal of surge beds in the bed availability count.

I downloaded the data base of hospitalization numbers that was posted on 11/27 and the same data base posted on 11/28.
Per the 11/27 data, the number of ICU available (staffed, but unoccupied) beds from 11/15 to 11/25 were:  
  264, 268, 248, 239, 235, 240,  95, 122,  68,  48,  56
Per the 11/28 data, those numbers are
   93,  97,  77,  68,  64,  69,  58,  85,  68,  48,  56
The difference is
  171, 171, 171, 171, 171, 171,  37,  37,   0,   0,   0

For available non-ICU beds, 11/27 data has
  741, 736, 617, 586, 597, 641, 604, 670, 534, 254, 273
11/28 data has
  516, 511, 393, 361, 372, 419, 378, 445, 446, 254, 273
Difference
  225, 225, 224, 225, 225, 222, 226, 225,  88,   0,   0

This may explain why Dr. Cody gave a 3 week date for overflow but my calculations showed room still available after 4 weeks.

I hope they publish the surge bed counts.  There is a lot of difference between sending people back home with no professional care than putting them in beds were they can get (say) 90% of the care they would have gotten if the hospital weren't at capacity.


Similarly, staffing for hospitals can be adjusted under emergency conditions.  Obviously no one wants to adjust staff under these conditions, but it is being done.  As one of our members pointed out, doctors (and nurses, etc.) do get asked to work in areas that aren't their specialty.  Not ideal, but hopefully they can deal with the somewhat normal requirements and can call in the specialists when required.

[BostonCard]

Back in the spring, I was getting hit up for ICU locus tenens work in New York.  The going rate was about double what I typically see advertised for locum work.  Come summer, I was seeing ads for work in Arizona, Texas, Georgia, and Florida, though the going rate was down some.  Now I’m seeing rates approach those of New York, but the work is throughout the country.  I imagine that if things continue, supply and demand working the way it does, the offers will continue to get more lucrative.  The problem is that unlike spring, where resources were needed desperately in a single area of the country, we are approaching a beggar-thy-neighbor situation.  There are only so many qualified MD’s in the country, and more crucially, there are only so many nurses and respiratory therapists.

BC

[DocSavage87]

Back in the spring, I was getting hit up for ICU locus tenens work in New York.  The going rate was about double what I typically see advertised for locum work.  Come summer, I was seeing ads for work in Arizona, Texas, Georgia, and Florida, though the going rate was down some.  Now I’m seeing rates approach those of New York, but the work is throughout the country.  I imagine that if things continue, supply and demand working the way it does, the offers will continue to get more lucrative.  The problem is that unlike spring, where resources were needed desperately in a single area of the country, we are approaching a beggar-thy-neighbor situation.  There are only so many qualified MD’s in the country, and more crucially, there are only so many nurses and respiratory therapists.

I remember the interview with a traveling nurse in El Paso, talking about how she had been in NYC but what was going on in El Paso with "the pit" put her over the edge.  I have nothing but respect for all essential workers dealing with overloaded areas, and wonder how many will need to take a break just to maintain sanity.  Things aren't going to get better for a while.

There were interviews with the UCSF folks who volunteered for NYC duty.  The stories they told were sobering, particularly the somewhat downplayed comments about how emergency staff were in positions they weren't really trained for.  I think this contributes, in part, to the increased bad outcomes as hospitals get overwhelmed.

I was amazed when I read that Sweden basically never moved elderly and those with high BMI to ICUs if they got bad.  They do triage at that level, and I wonder how Americans would feel if we adopted the same practices.

[M T]

I believe the new method of counting hospital beds is effectively measuring staff on duty on any particular day.

If you are any business administrator, how many extra staff do you want at work that you don't really need that day?
Of course it depends upon whether being short staffed is disastrous, whether workers' contracts prevents you from adjusting staff as need be, how predictable the need for workers is for any particular day or week, etc.

Would you keep having 50% more staff than needed?   20%?

If you were to keep 25% more staff than needed, as a hospital administrator you'd appear to have 20% free beds.  If you keep 20% more staff than needed, you'd have about 16.7% free beds.

I am not convinced that the new way of counting available beds is showing us anything more than the levels of staffing that the hospital is choosing to set from day to day.  

By the new numbers, in November, the total (occupied + unoccupied) number of ICU beds ranged from a high of 363 to a low of 321 (down 12%).   Non_ICU beds ranged from 2046 down to 1968 (down 4%).   The latest data is for Nov.30, at which point there were a total of 331 ICU beds and 2008 non_ICU beds.

Given this, I don't believe that the number of usable & unoccupied ICU beds is the number of "available" ICU beds (52) nor the total is 331, but is actually better represented as 84  of a total of 363 (23%).

[BostonCard]

Staffing (especially nursing staffing) is a challenging metric.  Most of the places I've worked in use a dynamic staffing model where a certain number of nurses are "on call" and will be brought in depending on staffing needs (usually determined by the nurse manager some time before the shift).  This does create situations where a physical bed will be available for a patient but a staffed bed won't become available until change of shift.  If that is the case, that would explain the high variability from day to day, but would be a dramatic underestimate, because some beds could be staffed if nurses can be called in.  Perhaps it is a count of "staffable beds", that is, the number of beds that could be made available if everyone is brought in.  Would be worth finding out, because depending on how you measure it, it could be a very soft count or a harder count of bed availability.

BC

[dabigv13]

Ancillary to this discussion, my hospital is postponing elective surgeries again starting next week. ICU covid utilization is at highest point of the pandemic now.

Before it was more for PPE preservation, my understanding is now its staffing- OR nurses and PACU nurses can be redeployed to inpatient wards.

[BostonCard]

https://www.nytimes.com/2020/12/01/us/ca...ticleShare

We have about 72,000 physical beds in the state (one of the lowest ratios to population).

https://www.latimes.com/california/story...ed-heights

Looks like 8,500 of those beds (1 in 9) are being used for COVID-19 patients.

For all the complaining about our public health commissioners, maybe their seemingly draconian restrictions may be because red lights are flashing throughout the state.

BC

[fullmetal]

It's already commonplace to see ICUs across the nation increasing their standard of medical need for ICU admission due to anticipated or observed ICU staff/bed shortages.  Those empty beds are *not* meant to be filled before we sound the alarm.

[M T]

https://www.nytimes.com/2020/12/01/us/ca...ticleShare

We have about 72,000 physical beds in the state (one of the lowest ratios to population).

Back in March, I quoted the AHA indicating California had 74K acute care beds.  On March 15, the governor indicated 74K beds with a surge capacity of 8K more.  On March 18, he indicated 88K beds.

The AHA (American Hospital Association) has a tool showing an estimate of hospital beds in use at a future date using UW-IHME Models, for all states.  You can adjust a slider for the date, and a slider for % beds used by non-COVID patients, and a choice for Best Case, Std, or Worst Case.
If you hover over California, they show some 85K beds of which 7361 are ICU beds.

Their default setting is 60% of the beds are occupied by non-COVID patients.  If you leave that setting as is, and move forward in time, on California is project to have this % of all beds occupied
Jan. 1: ALL: Best: 67%, Std: 73%, Worst: 87%,   ICU: Best: 80%, Std: 100%, Worst: 139%
Jan 8: ALL: Best: 68%, Std: 76%, Worst: 93%,    ICU: Best: 82%, Std: 107%, Worst: 156%
Jan 15: ALL: Best: 69%, Std: 79%, Worst: 99%,  ICU: Best: 87%, Std: 115%, Worst: 176%
Jan 22: ALL: Best: 71%, Std: 84%, Worst: 104%, ICU: Best: 91%, Std: 124%, Worst: 190%
Jan 22: ALL: Best: 72%, Std: 85%, Worst: 106%, ICU: Best: 96%, Std: 132%, Worst: 194%