Hospital bed capacity and usage across secondary healthcare providers in England during the first wave of the COVID-19 pandemic: a descriptive analysis

Abstract

ObjectiveIn this study, we describe the pattern of bed occupancy across England during the peak of the first wave of the COVID-19 pandemic.DesignDescriptive survey.SettingAll non-specialist secondary care providers in England from 27 March27to 5 June 2020.ParticipantsAcute (non-specialist) trusts with a type 1 (ie, 24 hours/day, consultant-led) accident and emergency department (n=125), Nightingale (field) hospitals (n=7) and independent sector secondary care providers (n=195).Main outcome measuresTwo thresholds for ‘safe occupancy’ were used: 85% as per the Royal College of Emergency Medicine and 92% as per NHS Improvement.ResultsAt peak availability, there were 2711 additional beds compatible with mechanical ventilation across England, reflecting a 53% increase in capacity, and occupancy never exceeded 62%. A consequence of the repurposing of beds meant that at the trough there were 8.7% (8508) fewer general and acute beds across England, but occupancy never exceeded 72%. The closest to full occupancy of general and acute bed (surge) capacity that any trust in England reached was 99.8% . For beds compatible with mechanical ventilation there were 326 trust-days (3.7%) spent above 85% of surge capacity and 154 trust-days (1.8%) spent above 92%. 23 trusts spent a cumulative 81 days at 100% saturation of their surge ventilator bed capacity (median number of days per trust=1, range: 1–17). However, only three sustainability and transformation partnerships (aggregates of geographically co-located trusts) reached 100% saturation of their mechanical ventilation beds.ConclusionsThroughout the first wave of the pandemic, an adequate supply of all bed types existed at a national level. However, due to an unequal distribution of bed utilisation, many trusts spent a significant period operating above ‘safe-occupancy’ thresholds despite substantial capacity in geographically co-located trusts, a key operational issue to address in preparing for future waves.

Restricted access to the NHS during the COVID-19 pandemic: Is it time to move away from the rationed clinical response?

“…The existing NHS bed quota were used to provide beds for COVID-19 patients and no actual increase in basic healthcare capacity has, to this day, occurred. Indeed, together with the effects of social distancing for infection control purposes, the NHS suffered an 8% reduction in usable inpatient bed capacity during the pandemic [28] .…”

A national retrospective study of the association between serious operational problems and COVID-19 specific intensive care mortality risk

“…Occupancy was defined as the proportion of surge capacity occupied on each calendar day. The full cleaning and preparation of the SitRep data is described in detail elsewhere [4], however, for this analysis an additional step was necessary as there are three dates where no data is available: 14 th May, 24 th May and 24 th November. To address this issue, a naïve imputation method was applied where the occupancy information for the preceding 24-hour period were used to forward-fill the dates in question.…”

“…The emergence of the SARS-Cov-2 pathogen [1], and the new more transmissible variants [2], has resulted in large numbers of people, requiring hospital admission, often to high-acuity critical care settings [3]. In the UK for example, some hospitals increased their intensive care unit capacity by over 200% at the peak of the first wave of the COVID-19 pandemic to address the increased need [4]. Despite these re-deployed resources, and even in combination with the introduction of non-pharmacological interventions to limit disease transmission [5], many UK hospitals far exceeded the nationally-defined threshold of 85% for safe operating capacity [4].…”

“…In the UK for example, some hospitals increased their intensive care unit capacity by over 200% at the peak of the first wave of the COVID-19 pandemic to address the increased need [4]. Despite these re-deployed resources, and even in combination with the introduction of non-pharmacological interventions to limit disease transmission [5], many UK hospitals far exceeded the nationally-defined threshold of 85% for safe operating capacity [4]. However, the concerns about the operational strain on health systems extends beyond the more superficial capability to admit new patients, as there is also a well-established association between operational strain and individual-level patient outcomes, including those in critical care settings [6].…”

David Oliver: Hospital bed numbers were inadequate before the pandemic and will continue to be so

“…Overnight bed occupancy was around 90% before the pandemic and exceeded that in serial pre-covid winters 8. We must be cautious in interpreting figures from the pandemic, because infection control measures and emergency discharge arrangements reduced the number of beds available, enabled faster clearance of beds, and led to elective work being cancelled and postponed so that occupancy fell below historical levels 9…”