Reports of limited hospital capacity for Oklahoma’s COVID-19 patients are largely a product of flawed measurement, not a true shortage of beds, state officials told lawmakers on Monday.
“Our goal of this entire plan is that Oklahoma patients are treated in a hospital-like setting and they always will be treated in a hospital-like setting,” said Oklahoma State Department of Health Surge Plan Advisor Matt Stacy. “And we believe, working with the hospitals, that’s there’s a lot of room to go.”
Oklahoma Commissioner of Health Lance Frye told members of the House Government Efficiency Committee that the state’s surge plan has used three different formulas to measure hospital capacity, but that the state has consistently had sufficient hospital beds to treat patients with the most severe COVID-19 symptoms.
Frye said the initial hospital surge plan was based on a simple number of beds available in state hospitals, using figures provided by the hospitals. At that time, hospital officials said they could increase bed numbers 40 percent if required and needed to reserve only 30 percent of capacity for non-COVID emergent patients, meaning they could fill up to 70 percent of available hospital beds with COVID patients.
“Now when we say they’ve got 15 percent or 20 percent COVID patients in their hospital, you can see how on our end we may not feel like we’re overrun because they said they could take up to 70 (percent),” Frye said.
Hospitals later requested to use a “staffing capacity” figure, and the state’s surge plan was modified to use that metric.
“That wasn’t perfect either because a great day for a hospital is to be at full capacity,” Frye said. “They don’t want nurses manning empty beds. They want their staffing to match up with the number of people in the hospital, which means they’re going to show zero capacity. They’re full.”
Oklahoma hospital officials have previously acknowledged that their business model always keeps intensive care units (ICUs) close to full, including prior to the pandemic.
During a July press conference appearance with Gov. Kevin Stitt, Jim Gebhart, community president of Mercy Hospital said, “For all hospitals across America, we manage ICU capacity very tightly.”
That point has also been noted in other states.
At a September roundtable on public health, Florida Gov. Ron DeSantis noted, “Before the pandemic started in Florida, we had 90 percent of our beds were in use at the beginning of March.”
When the staffing-capacity figure was used to determine bed shortages in Oklahoma, Frye said there were instances where a hospital would discharge patients and “have less patients in the hospital than it did the day before, but their ‘capacity’ looked like it worsened because they also got rid of some staff.”
He noted that hospitals set staffing levels based on the number of beds they expect will be filled with patients each day, taking into account factors such as discharges, scheduled surgeries, and anticipated emergency room traffic.
“They staff up or down every day based off of that,” Frye said. “So when you look at ‘staffed capacity,’ that’s a number that it changes every day.”
As a result, the state surge plan was modified again. Today, a hybrid version of the prior two models is in use, Frye said.
Stacy said the state has achieved its goal of treating COVID-19 patients in hospitals.
“We could have stood up 1,000 beds immediately in the Cox Center or other places like that, but that’s not optimal health care and we didn’t think we needed that,” Stacy said.
He said there are 5,673 available staffed hospital beds in Oklahoma, including med-surg and ICU beds combined, based on the latest survey of hospitals.
“That denominator is important, and so when we see a number of 950 hospitalizations, obviously it’s concerning because the trend is upward, but we see a lot of room there in hospitals to continue to cancel certain procedures that are non-emergent and elective,” Stacy said.
He said the decision to cancel non-emergency surgeries to free up bed space for COVID-19 patients is left up to hospitals.
“We’re asking hospitals to be hospitals and manage that, not ask the state to manage that …,” Stacy said. “Because we can’t manage their capacity. We’re not a staffing agency. We’re not a hospital. We don’t control patient-care decisions. We don’t control discharge dates.”
Stacy said that one sign of sufficient capacity is that no hospitals have instituted their own surge plans as of Friday, Nov. 6.