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Inpatient bed staffing, managing hospital capacity

Notes from the COVID front lines: managing hospital capacity in the latest wave

Pallabi Sanyal-Dey, MD, FHM

Director Client Services, iQueue for Inpatient Beds Associate Clinical Professor, UCSF School of Medicine

The recent onset of new COVID-19 variants — Delta, Omicron, IHU, and others — plus a stronger flu season than last year are forcing hospitals to struggle and scramble to treat patients amid renewed staffing and supply shortages. Managing hospital capacity, though always critical, has rarely been so urgent.

Through ongoing conversations with our iQueue for Inpatient Beds customers, who collectively manage over 4,000 beds across the country, LeanTaaS gained valuable insights into how health systems are addressing the prominent questions that arise from elective surgery protocols, inpatient geographic cohorting, acuity levels, and staffing shortages. They are also recognizing what is different about the circumstances now, versus 12 or 18 months ago, and how to adjust their approach accordingly. The following is a summary of these insights.

Managing elective surgeries 

During the first surge, elective surgeries were cancelled and hospitals were forced to reallocate perioperative staff to help with patient care elsewhere within the organization and/or furlough perioperative staff. During this current surge, several states have recommended delaying elective surgeries, while hospital systems in nearly half of all states have decided independently to postpone elective surgeries again.

Other hospitals are trying out new approaches this time around. One hospital system has increased the frequency of meetings to twice a week between the inpatient capacity and surgery teams to better gauge supply and demand. The system ultimately decided to continue scheduling and performing elective surgeries, a choice that was made possible since the number of elective surgeries had been naturally and steadily decreasing. Other organizations have made the conscious decision to forcibly decrease the number of elective surgeries, while noting the number of patients cancelling procedures has also increased. 

Geographic cohorting in the inpatient population

With this latest surge, units and floors that are designated for Medicine services are now overflowing with COVID-positive patients, which is creating problems placing subspecialty patients (i.e. cardiology, orthopedics). Beds that are normally “assigned” to those subspecialties are now temporarily occupied by these COVID-positive patients, an inevitable result of a challenging situation.  

There has also been an increase in the number of patients who present with a non-COVID medical issue (i.e. cardiac, stroke) but who also screen positive for COVID given the high transmission rates of Omicron. To ensure efficiency and quality of care, these patients are assigned, when possible, to a floor or unit where their primary problem can be treated. But this makes COVID cohorting much more difficult, as subspecialty units may contain both positive and non-positive COVID patients.

One organization is considering reactivating SARS “bubbles”, where certain floors are converted to negative pressure bubbles, thus functioning as isolation units accessible only to designated staff. This method was used during the first wave and was successful in helping to manage inpatient capacity and patient flow.  

A lower level of acuity in the inpatient population 

All the organizations LeanTaaS spoke with noted that patients are admitted with a lower acuity now than they were during previous waves. The use of Intensive Care Unit (ICU) beds has decreased for COVID-positive patients, as well as the lengths of stay. While this trend is a hopeful sign for the future, the increase in the sheer number of COVID-positive patient admissions is crippling. One organization is addressing this by building additional temporary Emergency Department space to help manage the large influx of patients.

Navigating staffing challenges 

Adequate staffing in hospitals can be a challenge even during “peacetime”. Hospitals have seen rising staffing shortages especially over the past two years due to burnout, early retirement, and quarantines after COVID exposure or infection. As a result, hospitals are evaluating the CDC guidelines and determining if they will enforce those specific guidelines or create their own “return to work” policies. Some states have relaxed their stricter guidelines, so that staff who have been exposed to COVID but remain asymptomatic can return to work. However, some organizations are still requiring all exposed staff to stay at home for seven days — working remotely, if possible — even if they are asymptomatic.

One health system is leveraging the decline in elective surgeries to creatively reallocate staff,  deploying those normally in the post-anesthesia care unit (PACU) to work on inpatient units instead. In some cases, elective surgeries are being cancelled by the hospital just so the PACU staff can be reassigned to care for the increased patients in those inpatient units.

Conclusion: managing hospital capacity in the long term

COVID is a reality hospitals will need to address for some time. Short-term solutions like reassigning staff or building temporary bed space can provide quick relief for the incredibly high volume of patients, but hospital leaders should evaluate long term solutions to emerge even stronger from the pandemic. LeanTaaS’ iQueue for Inpatient Beds solution can help match hospital supply with patient demand and support front line staff in ensuring the right patient is in the right bed at the right time – both now and post-pandemic. To learn more about this solution, or see success stories from health systems who have implemented it, please visit here.

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