Hospitals mobilize to build out ICU capacity, prevent ventilator shortages

Illinois Capitol News

SPRINGFIELD, Ill. (NEXSTAR) — Nearly a week after predicting intensive care unit beds across the state would fill rapidly in the wake of COVID-19, Governor J.B. Pritzker announced Tuesday that nearly half of Illinois’ available ICU beds are now occupied by patients who have tested positive for the virus. 

New figures released today by the Pritzker administration show that of the state’s 11,993 available hospital beds, only 949 are ICU beds currently open for additional patients. 

Illinois has a total of 28,139 hospital beds across the state, but only 2,709 of those beds are equipped for ICU patients.

The figure does not include beds recently made available at five alternative care sites, which are largely based near Chicago, although Pritzker said one site will be located in Springfield at the formerly-shuttered Vibra Hospital.

The Illinois Department of Public Health reported 13,549 known cases of COVID-19 statewide Tuesday. 1,166 of those patients — or nearly nine percent of the known infections — are currently occupying beds in intensive care.

One week ago, COVID-19 patients filled roughly 35 percent of all the ICU beds in Illinois. Today, that number reached 43 percent, an increase of eight percent, according to IDPH data. Public health officials have projected that trajectory to continue rising in the days to come.

“We can’t read too much into a single day’s jump, but these trends do offer us further insight into the overall reach of COVID-19 in our state,” Pritzker said. 

The statewide figures can fluctuate regularly as patients are discharged and others are hospitalized with new severe symptoms. The Pritzker administration has taken to publishing the hospital capacity data twice each week, though some Republican lawmakers have called for daily updates. 

Hospitals themselves are juggling a dizzying amount of new patient data while they await new medical guidance from county, state and federal public health officials. The rapidly-changing guidelines, compounded by the increase in ICU patient load, raise the stakes for hospitals, many of which are led by executives who are working through emergency protocols for the first time in their careers. 

Artificial Intelligence: new algorithms inform hospital executives to make on-the-fly decisions

OSF Healthcare turned to artificial intelligence to stem the tide of patients seeking COVID-19 tests at emergency rooms at their 14 locations across the state. The software, called Sto-Castic, attempts to piece together critical data points to build a mathematical model out of patient risk profiles. The model then projects what level of care that individual may need, and to give the hospital administrators a head start on building system-wide projections long before a patchwork of COVID-19 test results come back. 

Scott Levin, a professor at Johns Hopkins University, designed the AI software that OSF is using to steer patients through the proper channels.

“Based on how sick they project that patient to get, they can go in different pathways through the emergency department,” explained Levin, who also serves as Chief Technology Officer for Sto-Castic. “It also queues them and prioritizes them for the right resources in the hospital.”

He said the artificial intelligence algorithms are based on patient symptoms, vitals signs and medical history. They blend those figures with CDC data to provide early warnings to hospitals that project whether patients might need critical care or a surgical operation, or whether they can be treated at home.

Many of the data points collected for the OSF central nervous system are taken over the phone, reducing human contact and avoiding unnecessary trips to emergency rooms. 

“There’s a desire to keep patients away, particularly well patients, because there’s risks of them being exposed to COVID,” Levin said. 

Data sharing: state hospitals look to neighbors, state experts for best practices

Several downstate hospital systems have started sharing data to coordinate a regional response as they attempt to navigate a logistical labyrinth where a wrong turn could carry lethal consequences. 

“Our regional hospitals already collaborate closely to direct area patients to their more underutilized facilities,” Pritzker said Tuesday.

Pritzker said Peoria hospitals have “42 percent of ICU beds available and dropping, and places like the Edwardsville region at just 33 percent available.”

If one hospital system or region of the state starts to experience a logjam, the governor suggested he could play traffic cop. Pritzker said he could be “stepping in to direct ICU patients to underutilized hospitals myself, if need be.”

Critical access hospitals “have fewer ICU beds,” Pritzker warned. Many of them, such as the Memorial Hospital in Taylorville, had no ICU beds prior to the Coronavirus outbreak.

“We are accelerating some renovations to get more beds in place,” said Chuck Callahan, the CEO of Memorial Medical Center and President of the Memorial Hospital System’s hospital group.

At last count, Memorial Hospital in Taylorville had patients occupying seven of its 25 beds. Clusters of the Coronavirus broke out in two senior living facilities in the same town. Two of the patients who died of COVID-19 were treated in that hospital, according to Callahan.

While the Memorial hospital in Springfield includes more intensive care capability, the Taylorville location could also be adapted to handle a surge of patients.

“Certain units that don’t act as intensive care units today frankly could be turned into intensive care units if the surge would require it,” Callahan said.

Coronavirus crash course: cross-training nurses on respiratory illness

The state doesn’t only need bed space. It also needs trained medical professionals to staff those beds, and enough medical equipment to treat the patients.  

Callahan said Memorial’s hospital group is putting some nurses through “enhanced training” on the “unique features of the respiratory patient,” in the event they need to be redeployed to treat a surge of COVID-19 patients in intensive care.

Ventilator inventory: Could short supply force hospitals to cut corners? 

ICU beds are filling up at a faster rate than ventilators. New figures from IDPH show a five percent spike in statewide ventilator usage in the last week. On March 31st, 68 percent of the ventilators in Illinois were available for use. Today, just 57 percent of the state’s 2,791 ventilators are available and ready for use. 

The Illinois Department of Public Health is mobilizing a plan to move those free ventilators to where they are needed most.

Pritzker said the state is “investigating the need to move ventilators not just within a region of the state, but from region to region within the state as needed.”

Some hospital administrators, like Callahan, have said they currently have enough ventilators, and in a pinch, they could stretch the resources they have in place to treat more patients.

“There is now guidance coming that potentially could have two patients on one ventilator machine, which would allow you to be able to increase your capacity,” Callahan said in a remote interview last Wednesday.

Callahan referred to new federal guidelines from the U.S. Department of Health and Human Services, which describe ventilator sharing as a “possible crisis standard of care strategy,” but include warnings about “significant technical challenges that must be overcome.”

“The process of allowing a ventilator to be used by two people is not one that should be encouraged,” Pritzker cautioned. “It is one that would be an extreme last resort.

“I’ve heard that the use of two people on one ventilator is something that isn’t even medically considered appropriate in any way because the machinery of a ventilator doesn’t allow for adjustment for two different people on one machine,” Pritzker said.

“Actually they say they have enough power to do it if you have the proper hookups, and then, you know, the people who manage those [ventilator] settings manage it, and they partner the patients who can benefit from a similar ventilator setting. So it’s closed-circuit. So the machines have enough horsepower, if you will, to be able to do that safely.”

The state of California shipped 100 ventilators to Illinois overnight. The federal government has also shipped 600 ventilators to the state, contributing to its available stockpile. 

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