Beds: Questions of supply for all patients

BY PAUL MONIES
Oklahoma Watch
04/10/2020 08:30 AM
Main Cherokee Phoenix
Tents are set up outside of the emergency room at Integris Baptist Medical Center in Oklahoma City as the hospital prepares for coronavirus patients. WHITNEY BRYEN/OKLAHOMA WATCH
Main Cherokee Phoenix
Oklahoma Watch is a nonprofit, nonpartisan media organization that produces in-depth and investigative stories on important issues facing the state. For more Oklahoma Watch content, go to oklahomawatch.org. COURTESY
When a patient with COVID-19 is brought to a hospital, they are triaged, isolated and put in a negative pressure room (if it’s available), where air blows in but can’t escape.

Depending on the severity of the infection and patient’s age, they may end up in a succession of beds.

Those beds – intensive care, medical surgery, operating room – are critical parts of a hospital’s ability to effectively treat the victims of the coronavirus pandemic, as well as other patients. The bed itself isn’t pivotal, rather it’s the room’s or unit’s function, surrounding equipment and the personnel trained to perform in that setting – “the whole collection of care,” said LaWanna Halstead, vice president of the Oklahoma Hospital Association. 

If Oklahoma’s hospitals are overrun by COVID-19 patients, the concern is that few or no beds would be available. That could threaten the quality of care and the lives and safety of patients and health-care workers.

Health officials so far have signaled they want the state’s hospital systems to expand their bed capacity by 40 percent of normal capacity in the first phase of a COVID-19 surge.  

A second phase would involve field hospitals quickly built by the U.S. Army Corps of Engineers as part of a national contract with the Federal Emergency Management Agency.
  
“They’ve inspected a number of facilities in Oklahoma City and Tulsa,” Gov. Kevin Stitt said. “I sent them back to give us some more options from some of the rural areas of the state.” He said he wants to make sure needed care can be delivered to all parts of the state.

Other places where infection rates are severe have put those field hospitals in place, including in a New York City conference center, a Seattle arena and Detroit conference center.

Jerome Loughridge, Stitt’s health secretary, said those field hospitals could be erected as quickly as in a few weeks in Oklahoma. 

“Certainly in time for us to meet what would be the height of our surge,” Loughridge said Thursday. 

Since March 16, the state has been asking hospitals to report daily on the availability of different types of hospital beds.

Where those beds are now across the state is unclear from the daily report, although most are in large urban areas like Oklahoma City and Tulsa. A recent analysis by Kaiser Health News showed 50 of Oklahoma’s 77 counties without any ICU beds. 

Oklahoma’s ICU bed availability has remained fairly steady over the past week, at a rate of about 33% to 38% of total beds. On April 3, the state had 352 out 933 ICU beds available, according to the Oklahoma State Health Department.

Some of the early modeling shows the state needs between 4,000 and 6,800 beds to treat COVID-19 patients, Stitt said. The model, from April 1, shows Oklahoma hitting a peak around April 22. At that time, between 577 and 863 ICU beds would be needed. Officials have repeatedly stressed that there are no perfect models because so much is unknown about the extent of the infection. 

The state has a total bed capacity of 10,781, according to a review of COVID-19 hospital capacity by the Harvard Global Health Institute. In the past few weeks, the state’s total bed occupancy has averaged about 4,395, according to data collected for the governor’s office. (The state’s daily “COVID-19 Report” does not list total bed capacity.)

As the surge begins, officials expect to designate a hospital in Oklahoma City and one in Tulsa as the main COVID-19 treatment hospitals. Circling those sites will be hospitals that will expand their capacity to meet the needs in rural areas, Loughridge said. 

“These next three weeks are going to be really, really critical to continue to flatten that curve to keep us safe, make sure we don’t outpace the capacity at the hospitals,” Stitt said on April 1. 

Halstead, of the hospital association, said hospitals are evaluating bed space and how, if needed, they could transform certain types of beds or rooms into ones for more intensive care – “in the very, very worst-case scenario.” She referred to New Jersey, where some hospitals are using cafeterias for patient care.

“We hope so badly we don’t get to this point,” she said. 

Some Oklahoma City hospitals, including Integris Baptist Medical Center, have already constructed temporary expansions of their emergency departments. The addition is designed for triage and a 30-bed extension of the hospital’s ER.

“This new exterior space allows us the opportunity to keep the majority of those with the virus outside of our hospital, since most of those who have COVID-19 can be successfully treated at home,” the hospital said in an April 1 news release. “Patients requiring hospitalization will be moved from the exterior space to the appropriate care setting.”

Meanwhile, the Health Department said broader awareness of social distancing guidelines would help mitigate some of the expected surge. 

“Predicting human behavior is the most challenging part of predictive modeling,” the health department said April 3 in an unsigned blog post. “We have an opportunity to do the very best we can to self-isolate so we can get through this pandemic together. Each of us can make a difference.” 

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