New way to figure capacity for ICUs
Marin adjusts formula for determining available beds
Public health officials have changed the formula for calculating the intensive care unit beds available in Marin County on a daily basis during the pandemic.
The change was made soon after 0% availability was reported from Dec. 15 to 18. At that time, the county based its calculations on the assumption that Marin's three hospitals had adequate staffing to provide a total of 29 intensive care unit beds, about 75% of the ICU beds the hospitals are licensed by the state to operate.
Health officials stopped issuing daily reports on ICU availability in Marin on Dec. 20, but they continue to calculate the figure.
They are now adjusting their daily estimate of the total number of ICU beds available in the county after consultation with local hospitals.
“Unfortunately, the zero number created some alarm in our community that patients were going to be turned away at hospitals,” said Laine Hendricks, a county spokeswoman. “Some members of our community equate a medical surge with people overflowing into the parking lot. That's not necessarily the case.”
Hendricks said hospitals have some ability to boost their ICU capacity during surges beyond 29 beds. The primary limiting factor isn't beds or equipment — it is trained ICU nurses.
Normally, hospitals would bring in more traveling nurses during a surge in ICU cases, but because virtually the entire nation is coping with the coronavirus surge, traveling nurses are a rare commodity.
As a result, hospitals have to rely primarily on ICU nurses working extra shifts, or free up nurses by postponing complicated surgeries. This week, Kaiser Permanente San Rafael Medical Center said it is postponing some of its elective and non-urgent surgeries because of the virus surge.
MarinHealth Medical Center, the county’s largest hospital, has not postponed any surgeries during the latest surge, but its ICU is busy.
“I think we all felt it was somewhat concerning for the public to hear that the ICUs were at zero capacity,” said Karin Shavelson, MarinHealth’s chief medical officer. “We didn’t want the public to think we can’t care for them if they’re critically ill.”
She added, however, that “the resources are finite.”
“It’s not sustainable if the public continues to ignore recommendations around social distancing, masking and sheltering at home,” she said.
Shavelon said that as of 6 a.m. Wednesday, MarinHealth’s ICU was “right at capacity.”
Although MarinHealth Medical Center is officially licensed to operate 27 ICU beds, it only operates 19 ICU beds out of its new hospital wing.
“That is our physical bed capacity,” Shavelson said. “Just like every other hospital in the region, we often staff to what our historical data shows us our census is.”
That is the approach the county used in arriving at its original assumption that the county has a total of only 29 “functional” staffed ICU beds.
“The 29-bed figure was not something that was selected out of the blue,” Hendricks said. “It was done in consultation with our hospitals.”
Just as it can expand, the universe of functional beds in the county can also drop if a few ICU nurses call in sick. On Monday, health officials reported availability of ICU beds in Marin at 9%, based on an estimate of 23 total functional ICU beds in the county.
The 29- bed scenario credited MarinHealth with 14 functional ICU beds. Shavelson said on Wednesday morning the medical center was staffed for 11 patients, and it had 11 patients occupying ICU beds.
ICU capacity has become the focus of attention during the latest coronavirus surge. On Dec. 3, Gov. Gavin Newsom announced that he would begin issuing stay-athome orders in regions of the state where intensive care unit capacity falls below 15%.
Marin and four other Bay Area counties — San Francisco, Santa Clara, Contra Costa and Alameda — decided not to wait. On Dec. 4, they announced they were issuing preemptive stay-athome orders. Marin’s order became effective Dec. 8 and could extend to at least Jan. 8.
On Dec. 17, the Bay Area’s ICU availability dipped below 15%, and Marin became subject to the state order, regardless.
When calculating its estimate of ICU capacity in the state’s five regions, the California Department of Public Health gathers its own data directly from hospitals. The department adjusts the figures based on the percentage of ICU beds used to treat coronavirus patients.
If a region is using more than 30% of its ICU beds for coronavirus patients, then its available ICU capacity is lowered by 0.5% for each 1% over the 30% threshold.