Selected article for: "care bed and critical care hospital bed"
Author: Charles C Branas; Andrew Rundle; Sen Pei; Wan Yang; Brendan G Carr; Sarah Sims; Alexis Zebrowski; Ronan Doorley; Neil Schluger; James W Quinn; Jeffrey Shaman
Title: Flattening the curve before it flattens us: hospital critical care capacity limits and mortality from novel coronavirus (SARS-CoV2) cases in US counties
  • Document date: 2020_4_6
    • ID: b23301ac_12
    Snippet: Step-down bed counts were used where reported by hospitals in the four primary data sources; if hospitals did not report step-down beds, a 1:4 step-down-to-ICU bed ratio was assumed and ICU bed counts were multiplied by 1.25. One bed per OR was assumed. For hospitals that did not report PACU beds, a 1.5:1 PACU beds-to-OR ratio was assumed and ORs were multiplied by 1.5. One ventilator was assumed per critical care bed. The ability to put multiple.....
    Document: Step-down bed counts were used where reported by hospitals in the four primary data sources; if hospitals did not report step-down beds, a 1:4 step-down-to-ICU bed ratio was assumed and ICU bed counts were multiplied by 1.25. One bed per OR was assumed. For hospitals that did not report PACU beds, a 1.5:1 PACU beds-to-OR ratio was assumed and ORs were multiplied by 1.5. One ventilator was assumed per critical care bed. The ability to put multiple patients on a single ventilator in order to meet demands in a highvolume disaster was also incorporated into our estimates. 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 Counties with zero beds were not included in calculating the mean numbers of days prior to exceeding critical care surge limits for each county. A typical ICU length of stay for COVID-19 patients was used to calculate the daily discharge rate from hospital critical care beds to recalculate critical care bed need for each day of the study period. 32 Once a hospital's critical care bed capacity was reached, patients who could not be admitted -i.e., new critical care bed need minus critical care bed discharges -were aggregated to calculate excess deaths due to lack of critical care access. Prior reports of the hospital course of care for COVID-19 patients showed that the vast majority of those admitted to the ICU were critical and only one-in-five of those who were critical survived, mostly because of ICU care. Thus, the percentage of critically ill patients that should have gone to the ICU but did not and survived should be much lower, likely only 5%; we therefore assumed a 95% mortality for patients that would have been placed in a critical care bed but did not because their local critical care bed capacity had been exceeded. 33

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