Thread by @gbosslet

This recent COVID-19 surge has put a major strain on hospital systems

I am an ICU physician and we have felt it acutely in this area of the hospital

Indiana has somewhere around 250 ICU beds currently unoccupied in the state (out of ~2100)

How can 250 feel like zero?

A 🧵

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First, a word about statewide data.

Never has there been a microscope on these data like this, and the transparency is awesome.

Both @ISDH and @HHS keep track of hospital metrics regarding occupancy.

@ISDH data: bit.ly/3qLcNJh

@HHS data: bit.ly/3erSk6l

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We feel a major crunch in ICU beds

constantly moving people out of the ICU to accommodate transfers

currently there is always a list of people waiting to come to our facility from other places

many of which report that they are out of room

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And with these surges many hospitals have patients “boarding” in the emergency dept

waiting for a bed to open

getting ICU-level care in a place not designed for prolonged ICU care

This is not an ideal situation for the ICU, the emergency room, or the patient

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So, if there are over 250 ICU beds in Indiana, why this feeling? Why the crunch?

It is because of the way ICUs are (necessarily) designed and the way they must function

There are 2 main reasons why 250 beds in the state feels like zero

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First, all ICUs are not the same

In small hospitals, an ICU bed is an ICU bed

But in large hospitals, ICUs can be MEDICAL, for medical problems (like #COVID19)

Or SURGICAL, for patients who have had or need surgery

(or other, for even more specialized care)

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With these surges, many places have morphed surgical beds into medical beds because they must

This is one of the reasons places have cancelled elective surgeries- to have ICU bed available for all the medical disease

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So of the 250 “available” beds in the state, some will be needed for other things

Like surgery patients

So this whittles away the “available” beds a good bit

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The second thing that makes 250 ICU beds seem like zero is that hospitals do NOT like to have all their ICU beds filled

This is not a nefarious plot to control supply

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Most hospitals keep at least one “code bed” in case a hospitalized patient needs ICU care

We do NOT like to fill this bed unless it is ABSOLUTELY needed

It is like the (very necessary) ICU security blanket

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So if every hospital in Indiana has a “code bed”, this reduces the functional available beds by a good number.

There are 132 acute care hospitals

And 35 “critical access” hospitals in Indiana

Source: bit.ly/3mAdWSD

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Critical access hospital defined as:

Provides 24-hour care

Has less than 25 inpatient beds

Average length of stay less than 96 hours

Let’s assume half of these have ICU beds

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So that is 132 acute care hospitals + 17 critical access hospitals with ICUs

= 149 ICU code beds in Indiana (and this is probably an underestimate)

250-149= 100 ICU beds readily available in Indiana

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It does not take much COVID to fill 100 ICU beds

In Indiana if cases go to 6,500 per day, we could theoretically fill this many beds in ~2 days

Which means we are constantly moving to get patients out of ICUs to get these new patients in

https://twitter.com/gbosslet/status/1474066467377266689?s=20

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So we are dancing

With the virus

With ICU capacity

And having less than 2 ICU beds available per hospital is a tiny number when dealing with exponential growth of cases

You can help

Get the vaccine

fin/