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COVID-19: What it means for a hospital ICU to be at capacity

By Edward Stenehjem MD

Nov 23, 2020

full ICUs

What does "ICU capacity" mean?

Capacity refers to the percent of ICU beds currently occupied. Generally, an ICU is considered functionally full when it reaches 85 percent capacity. Right now, many ICUs in the state are running at over 90 percent full, and based on what we know about positive test rates, they’re about to get busier.

Why is 85 percent considered full? Doesn't that mean there are still beds available?

Yes, but think of it this way: When you take your mom to brunch at her favorite restaurant for Mother’s Day -- the busiest restaurant day of the year -- the place is humming. Every seat is full, every cook and server are working, and the kitchen is stocked with everything the chef might need. But if you show up at the restaurant on a random Tuesday and you happen to be behind a group of 20 tourists, the service might be slower and the kitchen might run short on your favorite dish, even though the restaurant is only 85 percent full. That’s because restaurants can’t afford to schedule their staff like every day is the busiest day of the year. If they did, they’d go out of business.

Right now, hospitals are operating like every day IS the busiest day of the year, and every day gets worse and worse. Plus, ICUs can’t fill every single bed. They have to keep a number open for emergencies like traumas or heart attacks -- patients who don’t have time to wait for a bed to become available.

What is an ICU?

The Intensive Care Unit is a section of the hospital equipped to care for the sickest patients. Rooms are set up for intensive patient monitoring. This can include equipment that continuously tracks and transmits information about a patient’s condition, such as cardiac function, blood pressure, oxygen levels, breathing, temperature, and more. The rooms also have large windows so that staff can monitor the patient visually, too. There is a higher ratio of caregivers to patients in the ICU. For example, a nurse may care for only one or two patients in the ICU compared to five or six on a standard medical/surgical floor. The rooms are large enough to accommodate equipment such as a ventilator or dialysis machine, which might not be possible in other units. And some ICU rooms have special systems to safely ventilate the air. All those capabilities are at the team's fingertips to use if a patient's condition begins to deteriorate.

Why does it seem like the hospital is quiet if the ICUs are maxed out?

If you peeked inside a hospital right now, it might not look like a hive of activity. COVID patients are too sick to drive themselves to the hospital. Instead, a loved one will take them, drop them off, then go home for their own safety. That means the parking lots are relatively empty. With heavy visitor restrictions, foot traffic is down in the cafeteria and there are no family groups waiting in lobbies. It can seem like a quiet place, but people are working frantically in the background.

Why should I care if ICUs are stretched to their limits?

Let’s assume that the pandemic continues at these high levels through the winter. Using historical data, we can predict that thousands, maybe tens of thousands, of Utahns will be headed to their local hospital with heart attacks, injuries, cancer, surgical complications, flu or pneumonia, or other serious problems that require ICU care. Most of us assume that high-quality medical care will be waiting for us when we need it. As COVID numbers continue to climb, there’s less assurance that care will be there for you, your parents, grandparents, best friends, or kids because all of the beds will be occupied by COVID patients.

Is patient care being affected right now?

Unfortunately, yes. The care that hospitals are providing right now is not the same care as it was four weeks ago. Caregivers from other sections of the hospital are providing ICU care right now. And while they are dedicated and skilled, they don't have the same training and expertise as members of the critical care team. A team of ICU nurses from New York City is in Utah to help, but they are unfamiliar with systems and procedures.

Are other areas of the hospital being converted into ICUs?

Yes, non-ICU rooms are serving ICU patients in many hospitals right now. Adult patients under age 30 are currently being admitted to pediatric units at Riverton and Primary Children’s Hospitals. Non-COVID patients are being sent to the orthopedic hospital.

So what if the worst happens and I need to enter the hospital. Should I worry?

It takes two answers to cover this one.

  • First, don’t delay if you have an urgent medical problem. Emergency rooms around the country are seeing patients who put off treatment because of the virus. Hospitals are admitting patients with severely infected wounds and damage from delayed treatment for heart attacks or strokes. That can have devastating consequences.
  • Second, we should all do everything we can so that if we are one of the unlucky ones who need advanced medical care, we get the care we need, when we need it most.

What's the worst case scenario?

The worst case would be not having the equipment (e.g., ventilators) or staff to care for patients when they need us most. That happened in New York City last spring and other places around the world, and it’s a very real possibility that it could happen in Utah, too. So far the state has been able to hold down mortality rates because of highly coordinated, skilled caregivers. But we could see the death rate rise as COVID admissions climb and the system is further strained.