THE CHARLOTTE OBSERVER
As hospitals across North Carolina prepare for a possible surge of patients infected with the coronavirus, it is not clear whether enough medical staff are available to provide adequate care or whether the state has enough equipment, including hospital beds and ventilators.
Hospitals are tracking and publicly reporting some statistics related to their capacity to treat patients, including the number of available beds and ventilators at their facilities.
The most recent state data on the number of hospital beds is from September 2018. That total – 21,222 beds – is the number licensed by North Carolina health regulators.
“A lot of times, hospitals don’t have all their licensed beds staffed,” said Cody Hand, senior vice president of the N.C. Healthcare Association. “That’s taken us a few weeks to tease out how to get the right data and the most useful data.”
State health officials are now surveying hospitals to get figures on beds and ventilator capacity. But that process is voluntary, and not every hospital responds consistently.
In the last week since the state began reporting hospital data, the response rate has averaged about 80 percent.
That should account for the majority of beds in North Carolina, since the larger hospital systems are responding consistently, Hand said.
But there’s no information on staffing levels, a crucial factor – along with physical space and protective gear – that can limit the number of patient beds available.
Individual hospitals, rather than the state or his association, are tracking staffing on their own, Hand said.
“We don’t do it consistently at NCHA for a reason, and that’s because our hospitals are already answering a lot of federal and state surveys,” he said. “Adding another question is really, at this point, not beneficial.”
For now, the NCHA does work with staffing agencies and hospitals to relocate healthcare personnel where surge capacity is needed.
STATE DOESN’T TRACK STAFFING DATA
An effort this week to find a dataset to track staffing levels at hospitals across the state was unsuccessful.
The North Carolina Department of Health and Human Services has not released any data on staffing levels, and a spokeswoman confirmed late Thursday afternoon the agency is not tracking the data.
Reporters from six newsrooms across the state sent questions to hospital systems in North Carolina. Most didn’t respond. With the exception of one hospital system, the answers hospitals did provide did not include specific staffing numbers.
The goal was to find data to gauge whether hospitals will be able to adequately care for coronavirus-infected patients, even if they have enough beds and ventilators.
The size of that workforce can make a big difference in a hospital’s capacity.
At Cone Health, for example, the network’s four Triad-area hospitals can currently staff about 600 beds between them. At “flex capacity,” according to a spokesperson, that number can increase to nearly 900 beds — if the hospitals can find the personnel to staff them.
Each COVID-19 patient admitted to the hospital to treat the virus needs a squad of health care workers — not just doctors and nurses — to care for them, whether in the ICU or a less-severe acute care unit.
“Staffing is determined by the condition and diagnosis of the patient,” explained Meghan Berney, a spokeswoman for CaroMont Regional Hospital in Gaston County.
Berney explained that a COVID-19 patient on supportive oxygen therapy — which could range from simple supplemental oxygen to sedated intubation — would need a care team including the following:
▪ Registered Nurse – from a 1-to-1 or 3-to-1 ratio, depending on patient condition
▪ Certified Nursing Assistant – depending on patient condition and nurse ratio from above
▪ Hospitalist – inpatient physician
▪ Intensivist – critical care physician
▪ Respiratory Therapist – depending on patient condition
▪ Specialist(s) – should a specialty physician consult be needed (cardiac, neuro, pulmonary, etc.)
▪ Ancillary staff – phlebotomists, environmental services, food services, facility services (these staff would be limited depending on patient diagnosis)
Hospital administrators say the defining factor in their ability to care for sick patients may be whether they have enough qualified and healthy staff to tend to them.
“There’s a facility footprint and then there’s a human resource footprint, and trying to align those is tricky,” said Dr. Joseph Rogers, the chief medical officer for the Duke University Health System. “We can repurpose a lot of space. We can’t go out and hire a 1,000 new nurses or respiratory therapists or physicians.”