High Demand For ICU Capacity, Staff Makes Transferring Patients Difficult
Monday, December 14, 2020
Some San Diego County hospitals are experiencing delays or denials to transfer patients between facilities as hospital capacity, especially staffing, becomes increasingly limited during the recent rise in COVID-19 hospitalizations.
The region-wide availability of intensive care unit beds dropped to 2.7% on Monday in Southern California, which includes San Diego. Regions trigger new stay-home orders after ICU capacity falls below 15%. The restrictions went into effect in San Diego last week.
However, the state’s figure does not measure actual remaining capacity because it is adjusted downward if a region has at least a certain percentage of COVID-19 patients occupying its ICU beds.
“If a region is utilizing more than 30% of its ICU beds for COVID-19 positive patients, then its available ICU capacity is reduced by 0.5% for each 1% over the 30% threshold. This is done to preserve the capacity of the ICU to also treat non-COVID-19 conditions,” the California Department of Public Health said in an emailed statement.
Locally the county reported on Sunday its remaining ICU space reached 18%, according to the KPBS Trigger Tracker, but county officials previously said the metric only tracks open beds and does not consider the availability of health care workers.
What's driving coronavirus surge? Check out the KPBS Trigger Tracker
Limited staff is making it more difficult to accept patients from other facilities, said Sharp HealthCare Chief Operating Officer Brett McClain.
“Maybe we need another five, six hours to fix that, to be able to move on. And I would say that's the case for everybody,” McClain said.
Sharp and Scripps Health, San Diego’s largest health care systems, provided data last week to KPBS showing their ICUs reached about 90% full with 40 to nearly 50% of COVID patients. At UC San Diego Health, capacity recently reached 109%, a spokeswoman said.
UCSD Health Chief Clinical Officer Margarita Baggett said the system already had to turn down transfer requests from other facilities.
“I was walking my dog last night and I'm thinking of the patients on the transfer, what I have right now, I'm saying I hope that person survives so I can get them in … These are the kind of things you're thinking of in your brain because the demand is so high right now,” Baggett said Friday.
However, McClain said Sharp hasn’t received any denials to transfer patients to other locations, just that they were delayed.
About a quarter of UCSD’s ICU patients were there for COVID-19 treatment, while the rest were non-COVID-19 patients, including those in its burn unit — which Baggett said is the only one in the region — and trauma patients.
“We're seeing a lot more gunshot wounds, motor vehicle accidents, drunk driving again. So where you are right now, I had to open up an extra overflow unit so I could decant the amount of high-level trauma patients. I never had to do that before,” Baggett said.
Some beds are also holding surgery patients, but Baggett said UCSD is evaluating how to pull back on non-urgent procedures to create more room for COVID-19 patients.
“As we get more demand, not only our own patient population, but requests from other hospitals, we are postponing elective surgeries. We're not postponing all, but we're looking at a certain percentage that we need to, to help the community and to help our own patients,” she said.
Prime Healthcare, which operates Alvarado and Paradise Valley hospitals, did not provide exact data in response to a request from KPBS but said it has not had to transfer patients out.
“Patient census at both Paradise Valley Hospital and Alvarado Hospital are up across the board, although at the moment neither are in danger of going over-capacity,” spokesman Ben Macapugay said in an email Tuesday.
Palomar Health also said it hasn’t had to transfer patients out but that its facilities operate near ICU capacity year-round. A spokesman said there is additional room for other incoming patients and encouraged San Diegans to continue seeking care if they need it.
Kaiser Permanente said in a statement last week that it is “ready to meet the demands of potential rises in COVID-19 cases,” but directed a request for specific data to local officials or outside agencies.
Full CDPH statement on regional ICU capacity calculation
“The ICU capacity measure is standardized to reflect effective capacity in ICUs by looking at the percentage of COVID-19 positive patients in the ICU. If a region is utilizing more than 30% of its ICU beds for COVID-19 positive patients, then it’s available ICU capacity is reduced by 0.5% for each 1% over the 30% threshold. This is done to preserve the capacity of the ICU to also treat non-COVID-19 conditions. The ICU is an important tool to save lives for those with COVID-19 and other critical medical conditions such as cancer, heart attacks and strokes. If a disproportionate number of ICU beds are being utilized to treat COVID-19 patients, then patients with non-COVID medical issues may not be receiving or be able to receive the level of care they need.”
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