Surge Capacity and Capability

Most people only seem to think about the immediate risks of a looming pandemic – becoming ill or a shortage of hand sanitizer, masks, and toilet paper for whatever odd reason. I don’t even want to guess what the psychological rationale is behind hoarding TP.

What people miss are the impacts on the infrastructure. There are plenty of them, but I’m only going to introduce the concept of surge capacity today. Essentially, think of it as how many beds are available at a hospital beyond the ones that are occupied by patients at the moment. The occupancy is also known as the census in hospital terms. It’s simply the number of occupied beds. The last hospital I worked at was a large (>500 bed) metropolitan hospital. Our census rarely dropped below 95% of capacity. Therein lies the problem.

There are 792,417 staffed beds in 5,198 US community hospitals as seen on the above map. 2015 data indicates that occupancy was 65.5% across all of them, but it is important to remember that varies considerably by location (rural vs. urban) and season. /Without adjusting for season, data from 2016 indicates that there are 36% of beds available in urban settings and 57% in rural. It’s higher in urban in the winter months, when the census in urban hospitals means occupancy is well into the 90+% range. More evidence of that lies in data from 1981 that shows occupancy of hospitals with over 200 beds to be about 80%. That’s probably the more important figure, since a pandemic will hit urban areas much harder because of far less social distancing.

The concept of surge capability is to increase this number. That can be accomplished through early discharges of patients at low risk, offloading patients to smaller, outlying community hospitals with more bed capacity, and cancelling elective surgery. However, surgery is the primary revenue treat for a hospital, so that is usually off the table as a strategy in most circumstances.

That poses a challenge if there is a massive increase in patient volume due to a pandemic, and that is just one of the problems that will be faced by hospitals.

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