TMC changes figures for ICU
Charts caused confusion, officials say
Texas Medical Center hospitals stopped updating key metrics showing the stress rising numbers of COVID-19 patients were placing on their facilities for more than three days, rattling policymakers and residents who have relied on the information to gauge the spread of the coronavirus.
The institutions — which together constitute the world’s largest medical complex — reported Thursday that their base intensive care capacity had hit 100 percent for the first time during the pandemic and was on pace to exceed an “unsustainable surge capacity” of intensive care beds by July 6.
Then, after reporting numerous charts and graphs almost daily for three months, the organization posted no updates until around 9 p.m. Saturday, sowing confusion about the hospitals’ ability to withstand a massive spike in cases that has followed Gov. Greg Abbott’s May decisions to lift restrictions intended to slow the virus.
When the charts reappeared, eight of
the 17 original slides had been deleted — including any reference to hospital capacity or projections of future capacity. The TMC later called that update “incomplete.”
Following a Houston Chronicle story highlighting the missing charts, the TMC at 6 p.m. Sunday posted updated data featuring most of the original information with a few cosmetic changes, as well as some additional slides attempting to better explain the hospitals’ capacity.
Houston Methodist CEO Dr. Marc Boom stressed that the new data was not reinvented — all the figures and projection models are the same — but was simply reformatted in an effort to make clear that reaching 100 percent of capacity in an ICU is a moving target. TMC hospitals have a combined 373 beds, for instance, that can become ICU beds with a “challenging” but “doable” amount of effort, Boom said, with the reassignment of trained staff and equipment.
Doing so would take the TMC facilities’ combined 93 percent ICU capacity as of the Sunday report down to 72 percent, the chart shows.
Boom said he and his peers knew as the pandemic wore on that the measurement of ICU capacity the slides displayed was imperfect and did not convey the way they are run, but did not revisit the charts as quickly as they should have.
“This is just trying to be clear. We want to be as helpful as we possibly can,” Boom said. “Obviously, this got delayed a couple days because it’s complicated — you put 11 or so institutions together all trying to figure out something this complicated and trying to figure out how we express it a little bit more accurately — it took a while, a little longer than any of us would have liked, but simply because it’s complicated. I like what we came up with.”
The executives are working closely with Gov. Greg Abbott, Mayor Sylvester Turner and County Judge Lina Hidalgo, TMC CEO Bill McKeon said when sharing the new information with the local government officials Sunday night.
“They have all encouraged us to bring the most comprehensive, real-time information forward to help them make the most informed decisions as we all navigate the COVID-19 pandemic,” McKeon said.
The changes capped a week dominated by concerns over hospital capacity.
Abbott had expressed displeasure to hospital executives with negative headlines about ICU capacity, sources familiar with the talks said. Abbott spokesman John Wittman said any insinuation that the governor suggested the executives publish less data is false.
“The governor’s office believes all hospitals should be reporting accurate data to the state and to the public as often as possible,” Wittman said Sunday morning. “We demanded more information to share, not less.”
Last Wednesday, 11 TMC leaders issued a statement warning that an “alarming” increase in hospitalizations soon could “overwhelm” their systems.
The next morning, Abbott issued an order restricting elective procedures at hospitals in Harris and Texas’ three other largest counties, saying he wanted to ensure the facilities retained enough beds to deal with the surge of cases.
Shortly after, four of the 11 TMC CEOs held a video press conference to tone down the concern they had expressed in the letter just 18 hours before. Hospital leaders wound up “unintentionally sounding an alarm bell too loudly,” Houston Methodist CEO Dr. Marc Boom said.
Boom and his three peers — Dr. David Callender of Memorial Hermann, Mark Wallace of Texas Children’s
Hospital and Dr. Doug Lawson of CHI St. Luke’s — said their systems were not in imminent danger of turning away patients and had plans to accommodate the surge.
On Friday morning, Harris County Judge Lina Hidalgo moved the county to the highest threat level, however, warning that the current hospitalization rate is “on pace to overwhelm the hospitals in the near future.”
Elective procedures, which can require patients to recover from surgeries in ICU beds, reduce the ability of hospitals to absorb critically ill COVID-19 patients. Hospital revenues had plunged after Abbott last restricted elective procedures in late March.
In April — when the roughly monthlong ban was in effect — Houston’s health care sector shed nearly 33,000 jobs; Methodist and CHI St. Luke’s in mid-May said they had seen huge drops in outpatient surgeries and ER visits, and Memorial Hermann said a shift from elective procedures to COVID-19 care had reduced revenues and increased costs so drastically that $92 million in federal COVID-19 relief did not cover the system’s losses.
The CEOs also have said such restrictions impair their ability to provide needed care to other patients, warning that there will be long-term negative consequences for the community if conditions such as cancer, heart disease and other conditions don’t receive ongoing treatment.
The most significant change between the old and new slides — essentially, the gap between the
Thursday and Sunday reports — is how the hospital systems describe how COVID-19 patients may burden ICU capacity in coming weeks.
An old “early warning” slide reported base ICU capacity had reached 100 percent, and was marked with a red dot signifying a “warning.” The new slide no longer discussed ICU capacity but instead intensive care “census growth,” and was marked with an orange dot signifying “moderate concern.”
An old slide that had projected the TMC facilities would exceed an “unsustainable surge capacity” of intensive care beds by July 6 while its new version night predicted the hospitals would not enter that zone — now called “Phase 3” but functionally identical — for at least two weeks.
Boom said the new data’s less urgent tone is not driven by a change in the model that projects future ICU admissions but in the data that feeds it.
Abbott’s elective procedure restrictions have left fewer non-COVID patients in intensive care, he said, and the virus-positive patients now being hospitalized are younger and less likely to require ICU care than those admitted earlier in the year.
In Methodist’s first peak of cases on April 10, Boom said, 47 percent of admitted COVID patients needed ICU care. On Sunday, 25 percent of the hospital’s ICU patients had COVID.