Yale New Haven Hospital reported this week that 83% of its staffed inpatient beds and 78% of adult intensive care units are occupied — among the highest occupancy rates in the state, according to federal data. But Mike Holmes, senior vice president of operations, isn’t alarmed – yet.
“We’re not in crisis,” said Holmes. “We’re halfway to where we were in wave one.”
Yale New Haven, and other hospitals, can adjust and adapt to an influx of patients, adding capacity and reallocating staff and resources. That means simple “occupancy rates” can paint a misleading picture of a hospital’s ability to care for new patients, and Connecticut hospitals often have more flexibility than the numbers indicate.
This month, for the first time since the start of the pandemic, the federal government began releasing hospital-level data regarding space constraints, sharing 7-day averages on ICU units, in-patient beds and COVID and non-COVID admissions.
The data show that 11 hospitals reported staffed in-patient bed occupancy rates greater than 80%, while eight reported staffed ICU occupancy above that threshold, according to a CT Mirror analysis of data through Dec. 17. Thirty Connecticut hospitals report data to the federal government, although the U.S. Department of Health and Human Services suppresses data when the bed or patient numbers are too small.
A hospital’s ability to treat patients is constrained by three main factors: “space, staff and stuff,” said Dr. Mahshid Abir, associate professor of emergency medicine at the University of Michigan. And the availability of staff is central to any hospital’s flexibility, said Dr. Rohit Bhalla, vice president and chief quality officer at Stamford Hospital. Since the pandemic is no longer geographically concentrated and hospitals across the country are battling COVID-19, “our ability to scale up drastically is a bit limited when compared to the spring,” Bhalla said.
But even in normal, non-pandemic times, hospitals report high occupancy, Abir said.
Bed occupancy rates are snapshots of a dynamic process governed by admissions and discharges that can change hourly.
“Think of a hospital like a hotel,” Bhalla said. At different points in a day, a hotel’s occupancy rates can fluctuate wildly as people check in and out.
Most importantly, a single week’s numbers fail to capture surge capacity, or the ability of individual hospitals to scale up “staff, space and stuff” in response to increasing hospitalizations. This is something that hospitals routinely do over the course of normal operations, Holmes said. In its definition of a bed, Health and Human Services requires hospitals to report “active” beds that have been added or repurposed to meet current demand.
As a result, the average number of inpatient beds and ICU beds reported each week can change over time. A CT Mirror analysis found that five hospitals in the state — Yale New Haven Hospital, Bridgeport Hospital, Saint Francis Hospital, Danbury Hospital and UConn’s John Dempsey Hospital — have reported steady increases in staffed ICUs since July, when Health and Human Services began collecting this data.
Yale New Haven Hospital has had the most significant increase in beds of the five, reporting a 20% increase in ICU units when compared to its 179-unit summer baseline. New Haven County currently has the highest population-adjusted hospitalization rate in the state, just ahead of Hartford County.
If needed, Holmes estimates he can increase ICU capacity by about 50% for a short period of time; over the summer, during the pandemic’s peak, Yale New Haven surged by 40%. The average length of stay in an ICU for COVID-19 patients has decreased since the spring, Holmes said, which allows for more efficient use of each unit.
By comparison, Stamford Hospital’s 32 units — 20 ICUs and 12 intermediate care units — have held steady since the summer, Bhalla said. “We were fortunate in the summer to have very little activity related to COVID-19 in the hospitals,” Bhalla said. “We’re not at the point now where we’ve created any additional ICU beds.”
In the spring, Stamford had to effectively double the number of ICU units to accommodate around 60 COVID patients in need of intensive care. “In the spring, we had to utilize areas like our catheterization lab and recovery and operating room areas as intensive care unit beds,” Bhalla said.
Large, urban hospitals are less worried about high bed occupancy rates than smaller, independent hospitals, which have less leeway to surge, Holmes said — 80 percent occupancy can be highly concerning in one hospital and less so in another, depending on the size of the hospital and how much it has surged capacity already.
Ryan Panchadsaram, a founder of COVID Exit Strategy, is pushing for the release of daily, not weekly, COVID and bed numbers from Health and Human Services. The use of 7-day averages might lead to counter-intuitive results, such as occupancy rates above 100% in some parts of the country. Alternatively, some hospitals might not be accurately counting surge beds in their total number of beds in the way that Health and Human Services requires. Staff are “manually entering these things in every day,” he said.
Other ways to think of hospital strain
Health and Human Services does not release staff shortage information on a per-hospital basis. Data aggregated on a state level show that in Connecticut, there were two hospitals reporting “critical” staffing shortages any given day in the past week, while three anticipate shortages this week. What constitutes a “critical” staffing shortage is left up to hospitals based on their internal staff ratio policies, according to Health and Human Services.
An NPR analysis found that 18 states in the country reported that over 10% of all their available beds were occupied by patients with COVID-19, a warning sign that hospitals could be overwhelmed.
By that metric, 19 Connecticut hospitals also have reason to worry. But the threshold is largely arbitrary, said Abir.
“Ten percent is not a concern, 20% is not a concern,” Holmes said. “Forty percent … that’s when we need to get really creative.”
Though Stamford Hospital exceeds this threshold, Bhalla pointed to the fact that less than 50% of staffed and occupied ICU beds were occupied by COVID patients — the more telling statistic. “We know that the patients in the ICU are much more ill, have much longer length of stay, much more resource utilization and a very poor prognosis.”
Health and Human Services collects information on each hospital’s equipment supply but is not releasing that to the public.
Unlike in the spring, the state does not expect ventilators to be in short supply, said Josh Geballe, the state’s chief operating officer.
How the second wave differs from the first
Unlike in the first wave, hospitals now are continuing to perform elective surgeries.
The state has not established thresholds for cancelling elective surgeries, Geballe said. Individual hospitals have the discretion to decide when they will cancel elective surgeries, if at all.
Both Bhalla and Holmes said their hospitals would consider cancelling elective surgeries after doing all they could to respond to any surge first, citing the need to provide care to all community members. Hospitals also suffer financially when elective surgeries are cancelled, the CT Mirror previously reported.
The overall number of COVID hospitalizations in Connecticut has started trending downward slightly.
While no definitive reason has been cited, Bhalla attributes these trends to effective public health messaging from the state on “limiting the number of people at the Thanksgiving table,” he said. “I’d like to think that that had some beneficial effect.”
A New York Times analysis found that Connecticut and the Northeast more broadly had the greatest drop in congregations around the Thanksgiving holidays. Nevertheless, millions are traveling around the country ahead of Christmas despite CDC guidance to the contrary, according to data from Transportation Security Administration checkpoints, the New York Times reported.
Connecticut may not be in the dire straits that states like California are in, but Holmes reiterated the need to continue to wear masks and follow public health guidance. “You’re not going to jinx me,” he said.
The CT Mirror will continue to track all these metrics as part of its COVID tracker.