San Diego County Monitors Hospital Capacity But Not Everyone Agrees How To Track It
Editor's note: In an ongoing series, KPBS is examining data tracked by the county to monitor coronavirus in the region.
Friday, October 16, 2020
Photo by Tarryn Mento
The "spaceship" is on the fifth floor at Sharp Chula Vista Medical Center. Staff coined the cosmic nickname for the intensive care unit after noisy but crucial negative pressure systems were installed.
The suction in every room keeps contagions from seeping into the hallway and allows Sharp to safely host COVID-19 patients in any of its ICU beds.
California Gov. Gavin Newsom relies on a data-driven process that controls statewide restrictions on activities during the public health crisis, but the county metrics could trigger local decisions to impose further limits. A KPBS review of the county’s tracking system revealed San Diego government and health care leaders don’t always agree on how to count crucial resources, like hospital beds.
Digital hues of gold, green and black on a computer screen tell staff the status of every ICU room at Sharp Chula Vista.
Danisha Jenkins, director of critical care services, said the electronic bed board shows live updates on whether a bed is ready to save a life or just lost a life.
Early in the pandemic, capacity got so tight they transferred some patients to other Sharp hospitals. Nurses from UC San Diego Health even delivered baskets of snacks — from Cheez-Its to seaweed crisps — to keep up the Sharp team’s energy.
“Everyone was crying — the nursing community, especially during these times, is strong and powerful,” said Jenkins, a former nurse manager at UCSD.
Hospital and ICU capacity
ICU beds are tallied in addition to overall hospital capacity. However the ICU bed count focuses on vacancies — San Diego County set a threshold of 20% of beds available, regardless of staff. Capacity of all hospital beds is measured by occupancy. The goal is to stay below 80%.
The county's public health team wants at least 20% of the region’s ICU beds to be open or else it may consider restrictions to help reduce community spread. The level hasn’t fallen below 27% since the county set the metrics in late May.
While the health officials tally the number of empty, clean beds as available, Jenkins said it's more realistic to track the number of beds a hospital can staff.
For example, she said Sharp’s “spaceship” may have 40 unoccupied beds, but could only have enough staff for 30. That means beds that the county considers available may not always be ready to accept patients right away.
“If a hospital has 300 licensed beds, that doesn't mean at any given point they're staffed fully for 300 beds,” said Dimitrios Alexiou, CEO of the Hospital Association of San Diego and Imperial Counties.
Alexiou said closing the gap between open and staffed beds is not an unfamiliar situation; hospitals often have to add shifts and temporary workers for a surge of patients.
“If we got to the point where we didn't have (staffed) beds available, we would continue to work to find staff — it's what always happens,” Alexiou said.
The county wouldn’t agree to an interview but provided answers through email. Health and Human Services Agency spokeswoman Sarah Sweeney said, “Tracking ‘staffed’ beds will always look like the hospitals are almost out of beds and doesn’t accurately account for their ability to rapidly increase capacity and staff.”
Counting on hospitals
Hospitals report daily bed counts and scores of other data to San Diego County before most people have their morning coffee.
Seven of the county’s 13 metrics monitor impact on the region’s health care centers, including how many ventilators they’re using to keep patients alive.
Breathing machines were a major concern in the early days of the pandemic, but supply has been stable for months — San Diego officials want at least 25% of the region’s ventilators available and the region has been well above that, according to the KPBS Trigger Tracker.
The robust capacity is largely thanks to expanded supplies and public health orders to curb transmission of the virus. Plus, according to the hospital association’s Alexiou, more treatment options means hospitals aren’t turning to ventilators right away.
“That's where you're seeing, in my mind, more capacity because we try and use that as more of a last resort than a first resort,” Alexiou said.
Meanwhile, other treatment tools turned unexpectedly scarce.
Scripps Health Corporate Senior Vice President Barbara Price said dialysis was difficult to come by earlier this summer.
“The reagents used during dialysis went into incredibly short supply,” Price said.
She said COVID can lead to organ failure that requires dialysis, but couldn’t be certain if that alone caused a strain on supply — many non-COVID patients could’ve also needed dialysis.
The situation has stabilized, but Scripps Health CEO Chris Van Gorder said it was so dire at one point, he even called a doctor at the U.S. Department of Homeland Security for help.
“To his credit, he tried to look all over the place and he ended up calling me back and says this is not something that the US government stocks anywhere,” Van Gorder said.
The county does not track these tools as part of its 13 triggers, but spokeswoman Sweeney said officials are still aware of supply levels.
San Diego's public health officer may weigh more restrictions if half of the region’s hospitals saw their inventory of gloves, gowns, masks, shields and eye protection — known as personal protective equipment or PPE — dwindled to less than a 22-day supply.
But Scripps’ Price said items like pharmaceuticals, especially those in high-demand, were also important to consider as part of the county’s triggers.
“There are other supplies in addition to PPE that could impact our ability to take care of patients,” Price said in a follow-up email.
Yet Sweeney of the Health and Human Services Agency said some hospital leaders felt it was unsustainable to report so much additional data.
“The County decided to track the items we do, as reports on these supplies were already being made multiple times each week,” Sweeney said.
In a number
The surge at Sharp Chula Vista has subsided, but flu season is nearing and reminders of the influx that could come again are all around. Drawings from children spreading love and gratitude hang at the nurses’ station. Grocery bags of protective gear fill a former meeting room.
But for Sharp Chula Vista, the biggest mark from COVID is the ache of losing one of their own. Jenkins embraced lead ICU nurse Eloisa Salinas as they remembered Sharp’s longtime facilities manager.
“I had known this person for a long time, and I knew the family for a long time, and now it was the end of life for this person and it was heartbreaking,” said Salinas, who recently retired after nearly 40 years at the hospital.
Raul Romo, 51, was a new grandfather. Colleagues remembered how he painted his beard pink for breast cancer awareness and played Santa at Christmas. He died at the hospital in May after contracting COVID.
“The numbers are people, and some of them were our people,” Jenkins said.
Romo helped build the “spaceship” just before the surge hit Sharp Chula Vista.
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