That's 1 ICU bed for a Trauma Service Area with 360,000 people.

ICU bed status for other areas...

Brownsville TSA is 1 bed for 99,000
Corpus TSA is 1 bed for 157,000
Houston TSA is 1 bed for 84,000
Beaumont TSA is out of beds for 2 days straight (1.3 million people)
Waco TSA is 1 bed for 173,000
Nuevo Laredo TSA is 1 for 79,000

Most others are in the 1 bed for 30,000-50,000 range.

Texas Trauma Service Area Data

Only one ICU bed? The story on KBTX had Dr. Sullivan state there was 86% ICU occupancy in Brazos County as of Wednesday (today).

Dr. Sullivan: 'Wait and see' on masks; hospitals monitoring capacity concerns

1 STAFFED ICU bed

Because of furloughs?

I wouldn't get too hung up on it. Hospitals have an ability to increase the number of beds without too much issue. There are still a lot of open resources to go around.

Baseline ICU availability round the state the Texas DSHS puts out:

It isn't an issue of beds. For now we have plenty of empty beds/rooms available in the hospital. We don't have trained ICU staff to take care of those patients. Hospitals have a hard time retaining ICU staff in general, especially in Texas where the pay is relatively low. Generally speaking, we always run pretty stretched thin with ICU staff during the busy months and often rely on agency contracts to fill the gaps. Right now there's so much agency nurse demand and the census is so high in the ICUs that we are struggling to have enough staff available. Any ICU nurse who works travel assignments is going to go to California first because the pay is 40% higher.

We are currently using one of our stepdown units as a makeshift ICU. We are doing our best with stepdown nurses getting crash courses in some aspects of critical care.

Why in the world would staff delete my post on this thread regarding many comments here demonstrating a complete lack of understanding how hospitals are run? Those who think the limited number of ICU beds available is not a big deal are clueless. Sure many facilities have the physical space to increase bed counts, but the problem is finding enough qualified staff to cover those beds. It's not as simple as shuffling around current employees. People are being actively recruited from across the country to fill the expected void and not all hospitals, especially smaller safety net facilities are able to afford the significant increase in cost
This virus is not the financial boom many uninformed think it is. I'm chief of the medical staff of such a hospital in the Houston area and know a little bit about all of this. If TA staff can't handle reality, then maybe this forum has run its course.

I read your earlier post and didn't see anything wrong with it, but it was probably easy to interpret as critical without the context you're sharing in this post. Appreciate your input on the situation - I think a lot of us are just trying to understand the dynamic at play.

Ragoo said:

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Because of furloughs?

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As far as I know, ER docs and ICU docs and critical care nurses are not getting furloughed.

This has been a talking point by many to try and dismiss the idea that healthcare workers are getting crushed. You can furlough a plastic surgeon, or an orthopedist, ophthalmologist, etc., right now, because they aren't seeing cases, and most of their procedures are elective. But not all doctors are equally useful for critical care, and even general medicine. There has been a shortage of nurses for a long time, and there has especially been a shortage of critical care nurses.

I know some critical care fellows that are having to come in on their off days or leave other off service learning rotations to come work in the ICU to assist with patient load. Some ICU nurses are picking up an extra patient per shift. Normally they're 1:2, so 1:3 might not seem back, but that's a 50% increase.

Physical space isn't the issue, staffing with qualified individuals is.

Sarduakar said:

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1 STAFFED ICU bed

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correct - why would you staff a bed that isn't used - not fiscally smart

bigtruckguy3500 said:

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Ragoo said:

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Because of furloughs?

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As far as I know, ER docs and ICU docs and critical care nurses are not getting furloughed.

This has been a talking point by many to try and dismiss the idea that healthcare workers are getting crushed. You can furlough a plastic surgeon, or an orthopedist, ophthalmologist, etc., right now, because they aren't seeing cases, and most of their procedures are elective. But not all doctors are equally useful for critical care, and even general medicine. There has been a shortage of nurses for a long time, and there has especially been a shortage of critical care nurses.

I know some critical care fellows that are having to come in on their off days or leave other off service learning rotations to come work in the ICU to assist with patient load. Some ICU nurses are picking up an extra patient per shift. Normally they're 1:2, so 1:3 might not seem back, but that's a 50% increase.

Physical space isn't the issue, staffing with qualified individuals is.

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This. Nobody is getting furloughed in ER and ICU, it's all outpatient and elective stuff.

And anybody who doesn't think this capacity thing is an issue has obviously never worked in a hospital before,

If we go into the fall with ICUs already at capacity, before flu hits, it's going to be a nightmare.

What's really scary is two things.....

1) We get absolutely zero consistency of message from any leadership whatsoever.

2) This country is permanently divided and would rather fight over EVERYTHING than work together to beat something.

Fix those 2 things and this country can beat about anything. We make this a lot harder on ourselves than it could be if we did something really crazy like work together. I don't see that happening again in my lifetime though. In the age of Facebook and Twitter, everyone just want a fight.

Gizzards said:

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Why in the world would staff delete my post on this thread regarding many comments here demonstrating a complete lack of understanding how hospitals are run? Those who think the limited number of ICU beds available is not a big deal are clueless. Sure many facilities have the physical space to increase bed counts, but the problem is finding enough qualified staff to cover those beds. It's not as simple as shuffling around current employees. People are being actively recruited from across the country to fill the expected void and not all hospitals, especially smaller safety net facilities are able to afford the significant increase in cost
This virus is not the financial boom many uninformed think it is. I'm chief of the medical staff of such a hospital in the Houston area and know a little bit about all of this. If TA staff can't handle reality, then maybe this forum has run its course.

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Reality sometimes bites, but burying our heads isn't a solution. I hope your posts are never deleted again for providing informed, truthful, information. Yikes. Thanks for your participation.

Quote:

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correct - why would you staff a bed that isn't used - not fiscally smart

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Not the issue. The "staff" isn't available. That is the issue.

gomerschlep said:

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bigtruckguy3500 said:

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Ragoo said:

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Because of furloughs?

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As far as I know, ER docs and ICU docs and critical care nurses are not getting furloughed.

This has been a talking point by many to try and dismiss the idea that healthcare workers are getting crushed. You can furlough a plastic surgeon, or an orthopedist, ophthalmologist, etc., right now, because they aren't seeing cases, and most of their procedures are elective. But not all doctors are equally useful for critical care, and even general medicine. There has been a shortage of nurses for a long time, and there has especially been a shortage of critical care nurses.

I know some critical care fellows that are having to come in on their off days or leave other off service learning rotations to come work in the ICU to assist with patient load. Some ICU nurses are picking up an extra patient per shift. Normally they're 1:2, so 1:3 might not seem back, but that's a 50% increase.

Physical space isn't the issue, staffing with qualified individuals is.

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This. Nobody is getting furloughed in ER and ICU, it's all outpatient and elective stuff.

And anybody who doesn't think this capacity thing is an issue has obviously never worked in a hospital before,

If we go into the fall with ICUs already at capacity, before flu hits, it's going to be a nightmare.

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While I agree, a part of me also wonders if the burnout theory is correct, and if it isn't wiser to get as much of this out of the way as possible before flu season hits. I've been wondering that for a while. If the burnout theory holds true, we'd be well beyond our peak by that time. If we slow things down too much now, we might have more issues in the colder months. It seems once you lose control of this virus and it begins to spread, it keeps going until it hits a certain mark, even with masks, social distancing, etc.

Just a thought. No idea if someone can provide better information on that. But this seems so much better that we are getting our spike in the summer than it would be if it were November or December right now.

Carnwellag2 said:

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Sarduakar said:

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1 STAFFED ICU bed

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correct - why would you staff a bed that isn't used - not fiscally smart

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Because you don't have the staff.

The staffing situation isn't going to get any better. I personally know multiple ER and ICU nurses that have quit since this started. Just walked away to start an entire new career. Just decided it wasn't worth it anymore.

In looking back, it looks like a lot of the uninformed posts that prompted my original post were also deleted.

beerad12man said:

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Moxley said:

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It isn't an issue of beds. For now we have plenty of empty beds/rooms available in the hospital. We don't have trained ICU staff to take care of those patients. Hospitals have a hard time retaining ICU staff in general, especially in Texas where the pay is relatively low. Generally speaking, we always run pretty stretched thin with ICU staff during the busy months and often rely on agency contracts to fill the gaps. Right now there's so much agency nurse demand and the census is so high in the ICUs that we are struggling to have enough staff available. Any ICU nurse who works travel assignments is going to go to California first because the pay is 40% higher.

We are currently using one of our stepdown units as a makeshift ICU. We are doing our best with stepdown nurses getting crash courses in some aspects of critical care.

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So would it be prudent to say that, if/when we have another pandemic, training up a bigger medical staff, and more importantly, paying our medical staff more is probably a better solution than lockdowns? I'd rather donate more straight to the medical community than go through another situation like this again. But I don't know how realistic that is.

This is what scares me the most. Not the virus itself. For 98-99% of us, it's nothing more than getting the flu/cold. Well, unless there's long term effects I don't understand, but what's really scary is how this virus caused such a collapse. If we ever get something more deadly with an even higher hospitalization rate, it's really scary.

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So this is no easy task (the bolded portion), for a multitude of rasons.

1) It takes a significant amount of time to sufficiently train doctors and nurses in critical care. Assuming they want to do it in the first place. Often times it isn't the most lucrative option (for doctors at least), and then it's very high stress for nurses.
2) I know you say you'd rather donate straight to the medicla community, but the system as it is now is looking to cut medical reimbursement rates for everything. The government, private insurance, everyone. And big wig hospital administrators are finding ways to pay themselves more and more while doctors get paid less and less.
2) This is not the American/capitalistic way. We don't like thing going underutilized, and training up a large medical staff in critical care would be largely underutilized most of the time. This is bad for them retaining their skillset, and it's not very economical. If we have an annual pandemic, it would be one thing, but something coming around every 5-10 years would be deemed not worth the cost.

Instead, what if we do things like South Korea? Have a comprehensive plan in place in how to rapidly deploy testing and contact tracing. Then have leadership that decides sometimes the best decision might not be the most popular, but that a unified national approach is the best approach. Getting ahead of the pandemic is a lot better than reacting to it, at least in an ideal world.

bigtruckguy3500 said:

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Instead, what if we do things like South Korea? Have a comprehensive plan in place in how to rapidly deploy testing and contact tracing. Then have leadership that decides sometimes the best decision might not be the most popular, but that a unified national approach is the best approach. Getting ahead of the pandemic is a lot better than reacting to it, at least in an ideal world.

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We have pretty well blown this as country because we have seemingly had ZERO plan on just how we proceed. Having zero plan opens things up to leadership fights and jockeying. Combine that with our National desire to fight each other about everything and this is what we get.

My hope is that we actually learn something from this and be better prepared for the future. Of course, we'll probably fight each other about developing a plan too, so we probably won't.

we had a pandemic response plan.

https://www.cdc.gov/flu/pandemic-resources/pdf/pandemic-influenza-implementation.pdf?fbclid=IwAR0L2Mdh6-pwWYpDQ_pcvSRWRM6T772WNTqGfIp2pk9G2nm6ahP2d-2VsOc

Quote:

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Infection control measures are critically important for the protection of personnel. The primary strategies for preventing pandemic influenza are the same as those for seasonal influenza:
(1) vaccination;
(2) early detection and treatment; and
(3) the use of infection control measures to prevent transmission.
However, when a pandemic begins, a vaccine may not be widely available, and the supply of antiviral drugs may be limited. The ability to limit transmission and delay the spread of the pandemic will therefore rely primarily on the appropriate and thorough application of infection control measures in health care facilities, the workplace, the community, and for individuals at home.
Simple infection control measures may be effective in reducing the transmission of infection. There are two basic categories of intervention:
(1) transmission interventions, such as the use of facemasks in health care settings and careful attention to cough etiquette and hand hygiene, which might reduce the likelihood that contacts with other people lead to disease transmission;
and (2) contact interventions, such as substituting teleconferences for face-to-face meetings, the use of other social distancing techniques, and the implementation of liberal leave policies for persons with sick family members, all of which eliminate or reduce the likelihood of contact with infected individuals. Interventions will have different costs and benefits, and be more or less appropriate or feasible, in different settings and for different individuals.

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Good news, we're up to 3 staffed beds in B/CS today!

Could you politics regulars keep the politics stuff on the politics forum?

None of the rest of us care about the e-points you're amassing with past post "gotchas".