Tuesday, September 1, 2020

The ICU Capacity Equation: Beds AND Clinicians

Environmental & Science Education, STEM, Health, Medicine

Ed Hessler

Much of the concern about COVID-19, especially when it appears to be peaking or threatening to do so, is about beds,the raw physical number of them, especially those in intensive care units.

In an essay in STAT, Hayley Beth Gershengorn, a critical care physician and associate professor of clinical medicine at the University of Miami Miller School of Medicine, describes the other side of ICU capacity often missing from our COVID-19 equation: clinicians and health-care professionals including nurses, respiratory therapists and others. It is quite easy and certainly quicker to respond with beds than it is to train those who work in intensive care. This takes years. She asks "If we build ICU beds*, patients will come. But who will care for them?"

Overtime and increasing patient load, as Gershengorn points out, are the two most common ways to fill the gap but these are "emotionally and physically draining," and can lead to burnout. Another way is to recruit those without experience in ICU's. However, "clinicians are not interchangeable." Sometimes these recruits come from various parts of the country but "the key to delivering the best ICU care is a functioning ICU team made up of clinicians used to working together."

COVID-19 has exposed a deficiency in health care that was well known--there is gap between the supply of beds and the qualified ICU practitioners. So, the big question is "what can we do?" Quickly. In the short term. Two answers are surprisingly simple, make sense but one requires us--the public--to behave as though this is a real pandemic, not one that is going to magically disappear. COVID-19 can be nudged to move more slowly as it spreads. The other is a reporting requirement.

Gershengorn writes  "The first and most important step is to limit the spread of Covid-19: all Americans need to wash their hands, use face coverings when in public, and socially distance. Second, the number of patients requiring not only hospitalization but also ICU-level care must be publicly reported, along with the number of available hospital and ICU beds in each region and the number of available “well-staffed” beds — the number that can be covered by the typical clinicians working under normal conditions. Tracking these figures can help us all understand how much demand for ICU care can truly be optimally met in each community." (my emphasis)

*These are more than standard beds; they are ICU-capable beds--high level care rooms. In an editorial in the August 22 Star Tribune, the editors discuss and comment on a plan to boost ICU capacity nationwide. It would according to the plan "boost the number of ICU-capable beds by 2500 with the new capacity to be divided among the 10 hospital regions designated by the . S. Department of Health and Human Services." 

The editors also note that "the pandemic has been an eye-opening experience" exposing "disturbing gaps in our medical system." 

Dr. Gershengorn's plea is timely.

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