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Public health officials evaluating COVID-19 impact say transparency is critical to determine hospital bed capacity

Public health officials evaluating COVID-19 impact say transparency is critical to determine hospital bed capacity

COVID Rise (copy)

Nurse Lauren Graham puts on protective gloves before checking on a patient on a COVID-19 floor in September at Saint Francis Hospital in Tulsa.

Oklahoma has broken the overall COVID-19 hospitalization record seven of the past 10 weekdays the state has reported that data.

COVID-19 ICU hospitalizations also are at an all-time high in the state.

But Oklahomans don’t know what the specific numbers are within each hospital or hospital region because the state doesn’t publicly release that data. And there have been conflicting viewpoints in recent weeks between state officials and public health and medical professionals about just how strained or not hospitals are, with some patients being transferred out of the Oklahoma City metro area.

Dr. Dale Bratzler, OU Health’s COVID chief, said Friday that transparency is the best course of action for Oklahoma. He noted that the Healthier Oklahoma Coalition — he is a member of the group of medical and public health professionals — has asked the state for more transparency on bed capacity at individual hospitals.

“I think transparency is the best thing that we can do right now,” Bratzler said. “Let people understand where this disease is spreading, how many cases, what the reality is around hospitalization.

“Right now, it’s difficult sometimes even at a hospital for an emergency room doctor, for instance, to know where there’s a hospital that has a bed available without just making a bunch of phone calls. I think we need to continue to have as much transparency as we can.”

Overnight Thursday night, 792 COVID-19 hospitalizations were reported in the state, with 301 COVID patients in ICUs — a record. The state’s overall COVID hospitalization record was set the previous night at 793 patients.

A spokesperson for Gov. Kevin Stitt declined to say why the governor hasn’t released more granular hospital bed data for the benefit of the medical community and public.

Charlie Hannema, Stitt’s chief of communications, on Friday deferred all questions to the Oklahoma State Department of Health “as the lead agency working on these issues and best suited to provide specific answers.”

In a statement Friday, the Health Department said it is working to improve public release of data.

“OSDH is working with hospitals to release regional hospital bed capacity,” according to the statement. “Timing and details are not yet available, but we will keep media updated as more progress is made.”

This marks an advancement from Oct. 6, when Health Department Deputy Commissioner Travis Kirkpatrick told the Tulsa World that the agency was considering adding regional hospital bed capacity to its data dashboard but continued to “weigh the need for transparency with accuracy and timeliness.”

Incomplete picture

Bratzler said the Healthier Oklahoma Coalition is composed of the Oklahoma State Medical Association, Oklahoma Hospital Association, Oklahoma Nurses Association and other groups.

He said he thinks all of the group members are frustrated about “some of the lack of interventions to prevent the spread of disease.” He is a proponent of a statewide mask mandate but said people should take personal responsibility to wear a mask because even “pretty good data” show that cities with mask ordinances see slower growth in COVID-19 cases.

But another aspect, Bratzler said, is publicly releasing granular data to ensure that hospital physicians can quickly determine where there is bed capacity to transfer patients with as little delay as possible.

Statewide, the ICU bed availability snapshot has hovered between 10% and 13%, with the number of available staffed beds ranging from 101 to 124 out of 961 to 1,114 total. The total bed data shift each day depending on hospital staffing levels.

Bratzler said community hospitals that have available beds would prevent a region from entering the red zone on the regional risk map the state currently uses even though other hospitals are at capacity.

“So I just don’t think we’re getting the complete picture of what’s actually happening with respect to the ability of hospitals,” Bratzler said.

“I think the one thing that patients may find out is that if they have a serious medical condition — and it might not even be COVID — they may end up getting transferred to a different hospital or even to a different community to receive their care if the hospital is filled up.”

Tenuous or strained capacity

Dr. Jennifer Clark, a former hospital administrator, noted on Wednesday that October metrics are on pace to “far outstrip” September’s.

Clark leads the data portion of the COVID-19 sessions for Project ECHO, an Oklahoma State University Center for Health Sciences program that helps serve rural and underserved areas. She said COVID-19 is spreading at much higher rates in rural areas than urban and that there is “widespread community involvement” throughout the state.

As an example of how that affects hospitals, “ICU capacity is kind of very tenuous in Stillwater,” Clark added.

Dr. George Monks, president of the Oklahoma State Medical Association, said Friday that hospital capacity can vary from hour to hour but that many hospitals are strained.

“This is where having our state release the regional hospital capacity information on ICU and COVID beds is so critical,” Monks said. “We need that daily snapshot of this information to understand what’s going on. Our whole state surge plan is based on regional hospital regions, yet we are just not getting that information publicly.”

Oklahoma Army National Guard Lt. Col. Matt Stacy, a member of the Governor’s Solutions Task Force, said hospitals are doing a “great job” of managing patient case loads, which he said is a testament to health care workers.

Stacy noted that he isn’t involved in determining what kind of hospital data are released.

He said hospitals are functioning at close to staffed capacity, not capacity of licensed beds — which is an important distinction because “staff is very expensive” and hospitals operate as businesses.

“It is stressful but effective,” Stacy said of how hospital capacity is managed. “I don’t want to say it’s good, because I know it’s hard. There’s a lot of hard work happening.”

Hospital personnel are stressed “but doing a great job,” he said.

Hospital support

LaWanna Halstead, vice president of quality and clinical initiatives for the Oklahoma Hospital Association, said Friday that there is ICU capacity in every hospital region of the state but that it is limited in metro areas.

“While COVID is adding to the patient load, hospitals are still caring for all types of patients, including surgical patients,” Halstead said. “Occasionally a patient may need to be transferred to another hospital if one hospital is temporarily full. The capacity in hospitals changes continuously.”

The Oklahoma Hospital Association notes that Oklahoma has had a shortage of nurses and other health care professionals “for some time” and that the shortage is exacerbated by the pandemic.

Halstead said some nurses, especially temporary staff, go to COVID-19 hot spots for more money.

She previously said hospitals’ patient surge plans are no longer supported by state funding since the state Health Department canceled its overflow contracts at the end of September.

Stacy, who helps develop the state’s surge plans, said the state paid hospitals at least $60 million in federal CARES Act funds through the overflow contracts to help them prepare for a surge of patients. He said the state is still supporting hospitals in other ways.

The state wants to develop a long-term solution for improving the hospital system rather than pay for temporary staffing help with the remaining federal COVID-relief dollars that must be spent by the end of the year, he said.

The state increased testing capacity from 100 per day at the pandemic’s outset to 6,500 per day now, which bolsters data for decision-making, Stacy said. He said the state also has made massive investments in personal protective equipment to distribute to hospitals and clinics.

“We’re constantly replenishing the stockpile,” Stacy said.

He said Oklahoma is leading the nation in developing its inoculation plan, with health care workers the first priority once vaccine shipments arrive.

Additionally, he said the Health Department is working with the Oklahoma Hospital Association and hospital CEOs to revise the state’s patient surge plan to create new tiers and triggers, including a better distribution of patients and an updated hospital bed survey.

He said the state expects to release the surge plan — its third iteration — this week. The Health Department has asked hospitals to tell it what their needs are, as well as what thresholds make sense for their systems, he said.

“It’s probably going to vary by region, honestly, where those thresholds need to be for actions whereupon the state takes certain types of action,” Stacy said. “One of those actions could be at some point a reduction or elimination of elective procedures. There’s going to be a threshold for that because that obviously creates more capacity.

“It also has some negative health consequences because patients need some of those treatments even though they’re considered elective.”

There also will be a threshold for constructing field hospitals, although neither the Health Department nor hospital executives expect that to be necessary, Stacy said.

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"We need that daily snapshot of this information to understand what's going on. Our whole state surge plan is based on regional hospital regions, yet we are just not getting that information publicly."

-- Dr. George Monks, Oklahoma State Medical Association


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Staff Writer

I am a general assignment reporter who predominately writes about public health, public safety and justice reform. I'm in journalism to help make this community, state, country and, ultimately, world a better place.

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