Hospital Status Report

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fightingfarmer09
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6:28p, 3/19/20
I thought there was a thread on this, but couldn't find it.

We talk about all of the reports on cases and deaths, however the boogie man that the news uses is the overwhelmed hospitals. Yet I haven't seen any reports of hospitals overrun yet similar to Italy.

Anyone have any frontline reports on the status of the ICUs and hospitals?
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WorkerBee
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In reply to fightingfarmer09 • 7:23p, 3/19/20
fightingfarmer09 said:
I thought there was a thread on this, but couldn't find it.

We talk about all of the reports on cases and deaths, however the boogie man that the news uses is the overwhelmed hospitals. Yet I haven't seen any reports of hospitals overrun yet similar to Italy.

Anyone have any frontline reports on the status of the ICUs and hospitals?
Right now the hospitals I work at are trying to keep staff from getting Covid-19 and dealing with the influx of patients requesting testing. Other than that we have the ability to increase the number of ICU beds / total beds and have contingencies for adding staff as needed (all hands on deck, increasing prn / PT staff usage, lots of OT). Plenty of vents at this time.

One thing that we are trying to be proactive on is checking and asking about DNR status in the nursing homes and patients that we are currently managing. Also have staff on hand to work on that if patients start coming in. We have a large elderly population and a significant number of those are already DNR's. We will triage if necessary if it gets out of hand. I can assure you that an end stage Alzheimer patient will not be getting a ventilator in a worst case scenario. Our ethics committee has and is having meetings concerning this.

Other than that just trying to stay healthy. More worried about the general population panic at this time.

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AgED
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7:23p, 3/19/20
AG
Not an "over run" but a doctor reached out to me today and said they have gone to one mask per week as mask supplies are super low. If you are in the Houston area and have any N-95 left over from Harvey I'm sure there is a doctor that can use them.
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JW
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7:49p, 3/19/20
AG
Beginning to ration PPE
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Aries
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9:26p, 3/19/20
Cook Children's has cancelled all elective surgeries. Closed most of their ORs. They are preparing to have to use anesthesia machines as vents.

Harris hospital in Fort Worth will not be doing any port placements or removals for the near future. Seems they are reserving their anesthesia machines as well.
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fightingfarmer09
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In reply to Aries • 11:28p, 3/19/20
Just so I understand:

This is in preparation to a potential surge leading to a worse case scenario? Or completely expecting to pull all the stops because the cases are rushing in?

I think that's what folks like myself are confused on. The media says the hospitals are working overtime on this, but no major stories on hospitals currently overrun.
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jopatura
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11:32p, 3/19/20
AG
Family member is a hospital nurse and says they aren't busy on the ICU side, but the ER side is getting swamped from every Tom, Dick, and Jane trying to get tested because they coughed. In Texas. In the Spring. Also there's a lot of patients trying to argue against regulations (especially on visitors) which means they spend a lot of time dealing with frontline bureaucratic mess. Very little PPE which is most worrisome. All electives are getting cancelled not because of room/staffing but because there's no extra PPE.
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Aries
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11:41p, 3/19/20
In preparation to a surge.

I came home today to find my 5 year old with a fever, tachycardia, tachypneic, complaining of aches to her legs, headache, & mild cough. 101 temp after my husband had given her some Tylenol. Now i have been up to my elbows in COVID at my own work all week. The thought stabbed me that I brought it home to her. Texted my pediatrician who have me advice, reassess her in 1 hour. Saw improvements in 1 hour so no need to take her to an urgent care which would being an even more risk of exposure. But damn it was really real today.

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Bruce Almighty
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11:48p, 3/19/20
AG
My wife is an ER doc but we live in a city that so far, only has 8 confirmed cases and two major hospitals. She said the biggest problem is just the overall anxiety within the hospital. The patients, the employees, it's like walking on a tight rope where everyone is being extra careful about everything they do. There's the fear of getting sick (and stuck in quarantine, which stresses the hospital) but also bringing it home.
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aggieheart
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11:54p, 3/19/20
AG
I had a nurse tell me earlier this week that the problem they had so far was getting elderly patients released to go to rehab care. Nursing homes aren't taking anyone right now. Beds are full at rehab facility. So they are stuck with patients that would normally leave and beds are scarce.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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fightingfarmer09
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In reply to Aries • 12:02a, 3/20/20
So sorry to hear that, hope they feel better.

Fascinating stuff everyone.
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jopatura
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12:04a, 3/20/20
AG
Also family member says the best thing that could be done right now is for private practice doctors & urgent care to waive paying deductibles/copays upfront. She's in a poorer area and says that a lot of their patients are seeking the ER for treatment because they don't have to produce $$$ to be seen. She's seen a rise in flu/ear infections/sinus infections because people are freaked out about having coronavirus. If there was somewhere for them to go that was "free" it would free up triage for more serious covid cases.
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AustinAg2K
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12:06a, 3/20/20
NY Times said NY hospitals will run out of supplies in two weeks. They didn't really specify what supplies are, though, nor did they mention what sort of quantity the hospitals keep in hand (wouldn't surprise me if hospitals only keep a few weeks of supplies on hand normally). I would think NY and Seattle would be the only areas with hospitals overrun right now. They've been the hardest hit.
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Thomas Ford 91
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12:42a, 3/20/20
AG
It's fairly easy to calculate the real infection rate from total fatalities. 800 infections for every fatality. Current fatalities are 217. That's 170,000 infected. If 4% of infected need an ICU bed, we run out of ICU beds at 1.2 million infected. So, we're out of beds when we hit 1,500 deaths. If we continue to double deaths every 48 hours, we run out of ICU beds next Wednesday.
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Alta
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In reply to Thomas Ford 91 • 12:46a, 3/20/20
AG
How do you get your 800 infections number?
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fightingfarmer09
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11:16a, 3/21/20
Any new updates?

I'm kinda curious if the typical weekend ER visits are down?
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Aries
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In reply to aggieheart • 7:15p, 3/21/20
Best friend is a PT tech at a rehab place in Fort Worth. All new admits will go to the same hall. Quarantined for 2 weeks. All rehab has to be done in the room. No visitors allowed.

I'm dreading next week & how many people I will have to help test.

Thankfully we closed some clinics to consolidate staff.
We have moved out most non-chemo treatments for 2 weeks. A lot of docs are seeing pts via Telemedicine to reduce visitors to clinics.
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fightingfarmer09
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In reply to Aries • 7:17p, 3/21/20
The teleomedicine is interesting, I've always been disappointed how limited it was before all of this.
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OldArmyBrent
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In reply to Thomas Ford 91 • 12:29a, 3/22/20
AG
Thomas Ford 91 said:
It's fairly easy to calculate the real infection rate from total fatalities. 800 infections for every fatality. Current fatalities are 217. That's 170,000 infected. If 4% of infected need an ICU bed, we run out of ICU beds at 1.2 million infected. So, we're out of beds when we hit 1,500 deaths. If we continue to double deaths every 48 hours, we run out of ICU beds next Wednesday.

That assumes all beds are needed at the same time and that all infections, hospitalizations, and deaths occur at the same time. What about the flattening the curve thing?
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mazzag
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In reply to WorkerBee • 1:23a, 3/22/20
AG
Where are you located?
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mazzag
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In reply to AgED • 1:24a, 3/22/20
AG
Where are you located?
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mazzag
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In reply to Bruce Almighty • 1:25a, 3/22/20
AG
Bruce Almighty said:
My wife is an ER doc but we live in a city that so far, only has 8 confirmed cases and two major hospitals. She said the biggest problem is just the overall anxiety within the hospital. The patients, the employees, it's like walking on a tight rope where everyone is being extra careful about everything they do. There's the fear of getting sick (and stuck in quarantine, which stresses the hospital) but also bringing it home.


Where are you located? Bell county?
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Bruce Almighty
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In reply to mazzag • 1:43a, 3/22/20
AG
Springfield, MO
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Not a Bot
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2:19a, 3/22/20
AG
Not horrible for us yet. Severely restricting hospital access to non-staff/patients. Weird not having 3-5 family members in every room. Sitting areas roped off. No visitors allowed to leave rooms unless going to designated guest bathrooms and directly back to room. Screening everyone coming in.

Admits for resp issues picking up, most still waiting on test results. Really need an accurate rapid swab to help conserve PPE and cohort patients more effectively.
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Badace52
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In reply to fightingfarmer09 • 4:14a, 3/22/20
AG
fightingfarmer09 said:
I thought there was a thread on this, but couldn't find it.

We talk about all of the reports on cases and deaths, however the boogie man that the news uses is the overwhelmed hospitals. Yet I haven't seen any reports of hospitals overrun yet similar to Italy.

Anyone have any frontline reports on the status of the ICUs and hospitals?
My friend's wife works at a major center in New York City. He told me today they currently have 424 confirmed Covid-19 cases in her hospital and around 20% of those are in the ICU. She says they have tons of Covid testing kits but hardly any swabs left to perform the testing. She said they have around 1000 testing kits but only around 100 swabs left.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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wbt5845
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4:26a, 3/22/20
AG
My wife's hospitals biggest problem is the flood of people in the ER asking to be tested. Of course, the root cause of this problem is all the people who use her hospital's ER as their primary care doctor since they don't have insurance and never pay.
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Pasquale Liucci
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In reply to Badace52 • 9:02a, 3/22/20
AG
What dictates when someone is referred to ICU for COVID progression? Is this a 1:1 with needing oxygen?
Just trying to get perspective on severity of cases
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Texaggie7nine
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9:21a, 3/22/20
Hospitals here in Spain have put out a request to all businesses with 3d printers to get them to the hospitals so they can print out masks.
7nine
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Not a Bot
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In reply to Pasquale Liucci • 9:29a, 3/22/20
AG
Lester Freamon said:
What dictates when someone is referred to ICU for COVID progression? Is this a 1:1 with needing oxygen?
Just trying to get perspective on severity of cases


In this particular case (Covid) it would be unstable oxygenation / perfusion. Typically this means they are either intubated or have high likelyhood of needing intubation.

(edited for clarity as I thought you were asking why a Covid patient would likely need ICU)
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Badace52
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In reply to Pasquale Liucci • 9:29a, 3/22/20
AG
Lester Freamon said:
What dictates when someone is referred to ICU for COVID progression? Is this a 1:1 with needing oxygen?
Just trying to get perspective on severity of cases
It is at their doctor's discretion. All that dictates ICU status is patients who are not stable enough to be managed on the general floor in the opinion of the admitting physician. Some need close monitoring due to medication, some are on ventilators, some require frequent neurological checks, and some are on medication drips that have to be closely managed. Generally the ratio of patients to nurse in the ICU is either 1:1 or 2:1, but as we get busier that number increases.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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SkiMo
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9:32a, 3/22/20
AG
ICU has always be a scary acronym. Typically it translates to someone being in really bad shape. Should I be as scared of that "word" as I am. It's safe to assume that if you've been admitted into ICU the chances of you not making it go way up?
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Badace52
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In reply to SkiMo • 9:41a, 3/22/20
AG
SkiMo said:
ICU has always be a scary acronym. Typically it translates to someone being in really bad shape. Should I be as scared of that "word" as I am. It's safe to assume that if you've been admitted into ICU the chances of you not making it go way up?
ICU patients are usually less stable and often critically ill, so yes if you are admitted to the ICU your odds of death have technically increased. However, that are some people who are in the ICU for certain medications and neuro monitoring who are not necessarily at an increased risk of death.

ICU just means you need intensive (more than usual) care. Don't let the word scare you.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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Exsurge Domine
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9:44a, 3/22/20
My dad was admitted to ICU with sepsis a few years ago, he was pretty bad off, but the doctor explained that they were sending him to ICU as his medicine needed to be carefully titrated so it didn't crash his blood pressure, not that he was on the verge of death, he just needed more intense looking after
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Pasquale Liucci
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In reply to Badace52 • 9:46a, 3/22/20
AG
I guess I was just trying to correlate it to the mild/severe/critical breakdown of case progressions (approximately 80/15/5 is what I've seen most often).

Based on your feedback of 20% in ICU that seems fairly consistent with the above
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SkiMo
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In reply to Badace52 • 9:59a, 3/22/20
AG
Badace52 said:
SkiMo said:
ICU has always be a scary acronym. Typically it translates to someone being in really bad shape. Should I be as scared of that "word" as I am. It's safe to assume that if you've been admitted into ICU the chances of you not making it go way up?
ICU patients are usually less stable and often critically ill, so yes if you are admitted to the ICU your odds of death have technically increased. However, that are some people who are in the ICU for certain medications and neuro monitoring who are not necessarily at an increased risk of death.

ICU just means you need intensive (more than usual) care. Don't let the word scare you.
Thanks for the response. I think so many of us are just scared in general. Trying my best to just remain as calm as possible through all this.
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