As long as this has been going on, and as many stories as there are about ICU beds filling up, it struck me that I have no idea what typical ICU capacity is. No Covid, how many beds are typically occupied at any one time?
I don’t work in the health care industry, or spend any real time in a hospital. So, given that, it’s easy for me to form a picture of a nearly empty ICU suddenly filled to bursting with Covid patients. But from what I have read, typically ICUs are already filled at 70% capacity on any one day.
I guess my view on this issue is that with modern day, for profit or nearly for profit hospitals, pressure to “run lean”, the question of “how much extra capacity does any one hospital have” is “not all that much.” So for “ICU beds to be near capacity” takes a lot less than my initial mental picture.
Any thoughts here? Aside of everything else, are we too devoted to profit and “running lean” to ever be able to provide more capacity, should it be needed?
Here in Ontario (and Canada in general) with our not-for-profit hospitals we run very lean in terms of ICU beds. I understand we are typically at about 75% capacity. In addition, there are lower levels of care like the Cardiac Care Units that may have a staffing level about 1/3 that of a full blown ICU.
To give you an idea, we have 1100 beds for 14M people. In comparison, New York has about 3000 for 20M people so almost double per capita.
Canadian hospitals generally have a well-equipped emergency room close to the radiology equipment with anywhere from six to a hundred beds depending on size. Most have a “clinical decision” area for those who might avoid admission depending on an image or test result. There are usually standard medical (with or without telemetry), surgical (various types), obstetric, long-term, and psychiatry beds for patients requiring admission. Sicker patients may need more services, a cardiac unit, a trauma or burn unit, a step-down ICU or an ICU. Getting a patient from the ER to an ICU bed, even if the obviously needed, might require some persuasion, flattery and transferring the patient to another centre.
In Canada, before Covid, getting an ICU bed was not always easy. Since they are expensive, they were sometimes kept short staffed. Since they might be needed at any time, and profit is not a key factor, intensivists try hard to avoid filling them with patients that can be managed elsewhere. Not every hospital has an ICU - bigger ones might have as many as 30 or 50 beds, generally larger and more numerous in bigger cities.
In a bigger American hospital, there might be more than a hundred ICU beds. Bigger ICUs are in “designated trauma centres” and more populous cities. Even with the US having many more ICU beds than Canada per capita, they are still expensive to manage and use is curtailed. I would say in Canada before Covid ICU capacity of staffed beds exceeded 85%.
Part of the problem is ICU nurses are experienced in doing frequent neurovitals, looking after patients on respirators, complex comorbidities and/or monitoring lines and telemetry. Not all nurses or floors have these skills.
Just some stuff from my vacation spot favorite hospital, Robert Wood Johnson University Hospital, New Brusnwick, a Level 1 Trauma Center, 1 of 4 in New Jersey.
This is the place the medivac helicopters fly to.
Robert Wood Johnson University Hospital has a 621 beds
Coronary Intensive Care
Intensive Care Unit
Neonatal Intensive Care
Pediatric Intensive Care
Surgical Intensive Care
No, that’s not 621 ICU beds, that’s 621 total beds.
Fortunately there are 113 hospitals in New Jersey, for a total of 20,099 beds . . . but only 2,000 critical care beds.
My last two stays, last September and January, included at least one night in the ER because there were no available beds in the regular part of the hospital.
As a generalization, the USA doesn’t run a ‘lean’ hospital system. It runs a hospital system where, at a price, everything is available, any time you want it. To enable that, the system runs with spare capacity, and the cost is paid by users/insurance/community.
Aside from anything else, too devoted to profit and ‘running fat’ to ever be able to provide a good public health system, should it be needed …
I think you (general “you”) need to be careful with numbers like this.
A per person basis does not tell you if New York has more violent crimes, more drug users coming into the hospital, more traffic accidents, a more obese (unhealthy) population and so on.
NY may have more beds but maybe they need more beds.
Mayo Clinic’s St Marys Hospital in Rochester Minnesota has 200 ICU beds and 200 step-down ICU beds. It’s the largest ICU unit in the nation, according to Wikipedia, so that’s certainly atypical.
New Hampshire, as a state, has fewer ICU beds in total (282). This article from November notes that in typical times 3/5ths are full on any given day pre-pandemic. And this other article here from two weeks ago shows the needle hasn’t moved much, if at all, because only 105 people today are hospitalized for covid in any type of room.
How many people does that one hospital serve? Multiple millions? If not, yeah, that’d seem atypical unless there’s a lot more violent crime in that area.
It’s going to depend on the size of the hospital, and the level of care they provide. A 25-bed critical access hospital out in the middle of nowhere may have a 1- or 2-bed ICU unit that is used to keep a critically ill or injured patient alive until they can be transported to a bigger facility, whereas a place like the Mayo Clinic that does pretty much everything would have literally hundreds of beds, in multiple units. Theirs would also include pediatric and neonatal intensive care, something only a larger hospital would have anyway, and possibly a burn unit as well.
The 300-bed hospital I used to work at had a 20-bed adult ICU, and their newborn nursery was equipped for level II NICU treatment, which pretty much meant they could take care of any baby that didn’t need to be on a ventilator. We also had a MICU, which was transitional between the ICU and the general med/surg floor, and a dedicated cardiac unit for pre- and post-op heart surgery patients (and an occasional patient who needed their chest cracked for other reasons).
Most of our ICU patients were seldom there for more than a few days; most of the time they got better, once in a while they died, and sometimes they would need to be transferred out to a bigger hospital or one where they could get more specialized care.
My intensive care specialist told me that one of the things he learned directing intensive care was:
If you don’t eat, you die.
As a medical student and doctor he’d already learned that If you don’t breath, you die, If your blood stops or leaves, you die, If you don’t drink you die, but people can go for a long time without eating, much longer than ordinary medical emergencies. Being a doctor there confronted him with the fact that people who stay in Intensive Care for a long time need to have nutrition. And since it’s going into the blood rather than into the stomach, it’s not regulated in the same way that normal nutritional intake is: it’s up to the ICU to get it right. Even in ICU, you can wing it for a couple of days, but when it stretches out … if you don’t eat, you die.
Yes, when I went into the ICU in April of 2020 I was tested at least 3 times to make sure I was not positive for Covid19 before they put me in the normal ICU ward. They told me that the entire top floor of the hospital had been converted in a Covid19 ICU ward.
I was too out of it to count how many beds the ICU ward had, but from previous visits to the hospital I think like 20 units is normal size for a medium sized hospital.
Does this happen? Most ERs have a trauma room and the equipment for stabilizing critical patients. I’ve worked in small hospitals with a six bed cardiac unit. I’ve worked in small city hospitals with a twelve bed ICU. But one bed? They would be unlikely to have an intensivist. As usual, all the stuff is dumped on the ER…
“Our 12 patient-bed Critical Care Unit consists of two Level 1 ICU beds and 10 HDU beds, this unit specialises in supporting acute surgical and medical patients.”
I think that’s about a small as you can get around here, but that’s because of pressure to close smaller units.
Before ‘intensivist’ was a separate thing, the ICU was managed by an anesthetist.
or maybe a person whose condition deteriorated and they needed closer monitoring, for a short period of time. This would have been in the 1990s, so I’m aware things are much different now, but that’s what I saw, and I’m aware of hospitals that do indeed have this if needed. No, they wouldn’t have an intensivist, but they could certainly consult with one. Most critical access hospitals are part of a bigger health system, and even the ones that aren’t, know who to talk to.
Yeah, I remember one of my techs handing me a TPN (total parenteral nutrition) and telling me, “I heard this patient weighs 400 pounds. Why are they on this?” I replied, “Obese people need to eat. They need to eat less, but they still need protein and vitamins, so they heal faster.” Sadly, it’s also not uncommon for a morbidly obese patient to also have vitamin deficiencies and/or protein-calorie malnutrition. And they weren’t just ICU patients, either; plenty of them were on the med/surg floor.
TPN was usually ordered for people whose GI tracts had been/were expected to be insufficiently functional for a week or more. Otherwise, we would give Procalamine (IV amino acids) or D5 and some combination of NS for the calories. There’s a saying: “If the gut works, use it”. Tube feedings were handled by Food & Nutrition, not pharmacy, so I didn’t know much about those.
A surprising number of ICU patients are actually on regular diets. I did a double take the first time I was delivering something to the ICU, and saw a person devouring a plate of bacon and eggs.
The number of hospitalized patients with COVID-19 across Oregon is 1,085, which is five more than yesterday. There are 299 COVID-19 patients in intensive care unit (ICU) beds, which is four more than yesterday.
There are 51 available adult ICU beds out of 661 total (8% availability) and 333 available adult non-ICU beds out of 4,269 (8% availability).
The total number of patients in hospital beds may fluctuate between report times. The numbers do not reflect admissions per day, nor the length of hospital stay. Staffing limitations are not captured in this data and may further limit bed capacity.