‘Tripledemia’ and another wave of limited hospital capacity

It has become a familiar refrain to read and hear about concerns about hospital capacity in recent years. The latest threat to hospital capacity It is the respiratory virus season of the year, which is the first in which COVID-19 has co-circulated at high levels with influenza and respiratory syncytial virus (RSV). As COVID-19 has made startlingly clear, hospital overcapacity is not robust, and even lower in pediatric hospitals, and cannot be expanded during a sustained surge as easily as, say, the online platform. Zoom expanded during the pandemic. As hospitals navigate this year’s respiratory virus season, in which more than three-quarters of hospital beds are occupied, reviewing some of the factors that set the context for this situation helps identify possible paths forward. remedy it.

Empty hospital beds mean no admissions

Although many hospitals are not-for-profit entities, that does not eliminate the need for them to operate “in the black,” generating more revenue than expense. Revenue is generated by patient care, and simply put, an empty bed cannot generate revenue (similar to an empty hotel room). This incentivizes hospitals to cut or close beds that, in normal times, are often unoccupied. The shift of many procedures to the outpatient setting has also decreased the demand for inpatient beds.

regulatory restrictions

Coupled with the above is the fact that hospitals simply cannot expand their capacity without taking into account the constraints they might face from the state and local governments that govern their operation (regardless of a hospital’s “private” status). Hospitals are licensed for a certain number of beds and any increase in that number must be accepted by the relevant government authority. In some states, through certificate of need lawsCompetitors have the ability to object to any increase in capacity if there is no agreed “need” for it.

Even if a hospital can overcome those hurdles, it’s subject to the glacial pace of local zoning boards and the bureaucratic web they weave if new construction is needed. During the height of COVID-19, when capacity concerns were paramount, UPMC, a hospital system in the Pittsburgh area (where I practice), was unable to build a new hospital due to zoning board objections and the case is now in the Pennsylvania Supreme Court.

Hospitals are also limited in their ability to “convert” an adult bed to a pediatric bed, nurse-to-patient ratio, and the ability to use alternative care sites (such as tents in the emergency department parking lot) to evaluate patients.

Not all beds are staffed

It is also the case that a hospital bed is not really operational unless it can be attended by a nurse. In the current era, the supply of nurses is restricted as global nursing shortage to abound. Also, since nurses are not immune to respiratory viruses, their daily numbers can fluctuate as some are invariably unable to work due to illness.

solutions are hard

There is no easy solution to this problem and the current demand driven by RSV, influenza and COVID-19 simultaneously, what some call a “tripledemia” – it certainly won’t be the last time this problem arises. Although there is no quick fix, there are several actions that I think would help in the short and long term.

1. Load balancing via health care coalitions: In a patient surge event, it is important that hospitals in the same region or metropolitan area work as a coalition and balance the patient load to prevent a hospital from being flooded. This is easier said than done, as hospitals may oppose the transfer of patients to competing hospitals.

2. Repeal Certificate of Need Laws: There is no reason competing hospitals can stipulate how many beds a competing hospital wants to operate.

3. Allow flexibility in converting bed types, nursing staffing ratios, and alternative care sites: Much of the impetus that led some to advocate declaring a public health emergency for RSV was to seek this flexibility (which it already exists). because it is covered by the COVID-19 declaration). This type of flexibility should be something that is built into daily operations and not something that can only operate during an official declaration of emergency.

Four. Lift caps on immigration of nurses: To solve the nursing workforce shortage, it is important to lift limits on the immigration of nurses from other countries (even when politically powerful national nursing unions invariably oppose it).

If the US is going to have a health care system that is capable of absorbing the myriad of infectious and other threats it faces while still being able to perform its daily surgeries, obstetric deliveries, psychiatric care, cancer screenings and all the other vital activities that the communities they serve depend on must be empowered and enabled to do so.

Dr. Amesh Adalja is board certified in emergency medicine, critical care medicine, infectious diseases, and internal medicine. He is a Principal Investigator at the Johns Hopkins Center for Health Security. Follow him on Twitter: @AmeshAA