I dont think measuring hospital capacity by available beds by themselves is useful. Both parents are doctors and work in different hospitals. Both report a shortage of doctors and nurses and not enough ability to give care to all their patients due to simply not having enough time in the day.

You can have 20% free beds, but only 50% care capacity

That's an interesting point. I created a visualization of the number of hospitals reporting a "critical staff shortage" using the data provided on HealthData.gov. It looks like the number of hospitals reporting a critical staff shortage has been consistently around 10-15% since July of 2020.

https://healthdata.gov/Hospital/Copy-of-of-hospitals-reporti...

Do you think things could be less than ideal before a facility reports a "critical staff shortage"?

And those medical staff being the last line, with, as the article says "no one to take over if I need to tap out".

Collapse comes all at once, unexpectedly. Except for all the warning signs...

I've noticed this idea bothers some people, but I really think we need some sort of deputized health-care worker system set up.

Allow people to take a six-week course, that lets them do simple patient care and vitals testing, and removes as much rote-work from the actual professionals as possible. While I greatly respect the work that nurses do, I think that a large part of their labor each day is spent on simple tasks.

I think the legal and regulatory landscape is far too complex and rigid to let that happen, though.

Most hospitals have been having back office folks re deploy to do the drudgery for months now. Lots of stuff like stocking rooms, bed setup etc. Ohio has now drafted national gaurd units to help in our hospitals to pick up this slack as well. None of these folks can do direct patient care stuff like blood pressure etc but they can and do pick up nearly everything else.

Those numbers really don’t tell the tale. The problem with looking at raw bed numbers is that all kinds of not so good pressure valve mechanisms go into effect as bed capacity drops, such as:

* cancellation of elective and non-urgent surgeries, including back surgeries

* longer more intense hours for staff

* shipping patients to other hospitals, often out of state

* huge spikes in ER wait times

My personal experience knowing people at multiple levels in health care is that hospitals legitimately have been struggling with capacity issues every time that COVID spiked over the past two years.

There are a few things that this date could be hiding (not saying it does, just that it could). Did they cancel any significant number of non-urgent treatments because of covid? What do they call "staffed beds"? Has the number of staff per bed changed? How much overtime has the staff been doing during these two years?

I also find those numbers interesting.

I, with help from my clerk and my head nurse, called 50 hospitals trying to find available space for a sick patient that required transfer from my small rural facility (we had been at 100% ICU capacity -- only 4 beds -- for weeks, and full more often than not for months).

I called every major hospital in New Mexico, Arizona, Colorado, Utah, and Texas, with several in Nevada and Oklahoma as well. Every one of them reported they had no capacity to accept my patient for transfer.

I looked at the AZ and UT state statistics within a few days and was surprised to see them reporting much more capacity than I had been notified about when trying to find a bed for my patient.

A Reddit thread I started based in part on the experience: https://www.reddit.com/r/medicine/comments/r6bl1u/not_accept...

Our local trauma centers have been so full that local ERs have literally had people die in the ER from treatable conditions (requiring a specialist we don't have) while trying to find a place that could accept a transfer. It has been like this for months. Our hospital had to establish a separate team just to help make phone calls because the physicians were spending hours upon hours of their shift making calls in search of open beds instead of patient care.

I don't understand the discrepancy between my experience and numbers reported by the local state websites, but I think it might be premature to consider their reported data indisputable.

I cover a 15 bed ICU in one of the states you mentioned and have seen the discrepancy as well.

I noticed, starting in 2020, that our hospital's internal ICU bed-available data did not correlate with local press/internet data. I have access to internal, real-time, system-wide ICU bed-available data. (I'll say that we have some where between 10-25 hospitals, don't want to be specific as I don't know what management would think of posts like this on HN). Our internal system-wide data does not correlate very well with state-wide press/internet metrics either.

When on-shift I spend much time trying to find beds for patients as well as fielding calls from other hospitals that are trying to do the same. The data available on the internet and in the press does not reflect the situation in the trenches at all in our region. I'm not sure how it could as our internal situation changes every 10-15 minutes, sometimes, depending on the progress or deterioration of individual patients, staffing availability, discharges home, numbers of people waiting to be cared for, what day of the week it is (Fri, Sat, Sun, Mon are the worst), how bad the roads are, what time of day it is (most people arrive in the afternoon and evening), if a holiday has just ended, if a large/local event has ended (people tolerate terrible symptoms for holidays and events and come to the ER afterwards).

For the entire pandemic, the real-time in-hospital situation has been more dire than is reflected in the press or on data-accumulation sites like Johns Hopkins. It has been exhausting.

Could it be..if you have 10 beds open, but through staff resignations etc..maybe only enough nurses for 8 beds? and that's where the discrepancies lay?

Just looking at ICU doesn't tell the whole picture. Not all covid patients - confirmed or awaiting a test - are place in ICU. ICU beds are a fraction of the total. ICU and vent patients are obviously more likely to die but all those other covid positive patients are still in our hospitals. My hospital now has more positive patients, and patients overall than we ever have in the entire pandemic - or any other time for that matter. We just don't have the staff to maintain these sorts of levels long term, regardless of the beds we have. We aren't necessarily crumbling but it's definitely getting harder and harder.

I was corrected earlier in the pandemic: I thought Hospitals LOVED covid because of all the money they got for services.

Someone then pointed out that COVID prevents a lot of really high margin care, substituted instead for drudgery healthcare and is killing the hospital bottom lines.

I suspect what is REALLY going on here is a combination of both the surge of care for the explosive Omicron variant, and the loss of high-margin care is undermining the profitability again.

The four big mafiosos of US healthcare are Health Insurance, Drug/Device makers, Doctors/Hospital Providers, and the Malpractice Trial Lawyers. All four of them have REALLY powerful lobbying arms (even the Trial Lawyers, the least significant revenue wise and numbers wise of the four, but they are lawyers so they know how to gum up the system). They point to everyone else when the question of "why so expensive" comes up.

But it's all about the unsustainable profit margins/revenue structures in the US care system. If you see an article like this, I always suspect it's really about unsustainable profitability whatever complaining entity has setup.

To that end, any future infrastructure bill or covid package you should include a set aside for more doctor residence positions. Of the four factors you mentioned, a lack of doctors is the most significant factor in health care costs and limited availability in the US.

I think this is possible because it benefits three of the four groups that you mentioned to the detriment doctors. It even helps Hospital providers by driving down cost

This is part of the problem with the argument around hospitals being overrun. People don't have any context with what it means.

In reality it's not hospitals being 110% maxed out. It's hospitals inching closer to capacity at 80, 85, 90% which then requires hospital workers to start taking into account triage. It means elective surgeries and people that don't need help right now end up getting pushed back, even if they still need help that day or will die.

Daniel Wilkinson died as a result of not getting treatment for something that is very easily treatable in a hospital [1] during the last wave. Multiple hospitals across multiple states couldn't admit him. This is what it means when the healthcare system crumbles: People start dying from otherwise treatable problems.

[1] https://www.click2houston.com/news/local/2021/08/28/houston-...

From what you're saying, I'm inclined to agree as well. It seems like the media is constantly panicking about ICU bed levels but we can just as easily go online and look at the publicly available numbers ourselves and see that it's a different story.

I wonder if hospitals being overrun is not because of ICU bed capacity, but the support staff needed to support those beds.

The beds can be there, but if nobody is there to take care of them, it's a whole other issue. Not sure how anybody is measuring "capacity" (whether it's the physical beds themselves as the metric, or if it includes support staff)

I don't think there's any "right" answer here, which sucks. Hopefully this pandemic gets done and over with this year.

You are correct, in my hospital system beds haven't been an issue since the early days of covid. Staff is the big issue. We are consistently over 100% nurse utilization. Having an open bed is useless if we can't put you in it and subsequently take care of you in a timely manner.