Us Hospitals: Occupancy Rates And Trends

As of 2018, there were 5,534 registered hospitals in the US, with about 70% being non-profit. The Covid-19 pandemic has put immense pressure on healthcare systems worldwide, and the US is no exception. In December 2022, hospitals in the US were fuller than they had been throughout the pandemic, with over 80% of hospital beds in use nationwide. While only about 6% of beds were in use for Covid-19 patients, the broader respiratory virus season was in full swing, with the US Centers for Disease Control and Prevention reporting that all but six states were experiencing high or very high respiratory virus activity.

Hospitals at fullest point since the pandemic began

According to a CNN analysis of data from the US Department of Health and Human Services, hospitals in the US are at their fullest point since the Covid-19 pandemic began. More than 80% of hospital beds are in use nationwide, up from 70% for most of the pandemic. The only other time hospitals were at 80% capacity was in January 2022 during the height of the Omicron surge, when a quarter of hospital beds were used for Covid-19 patients. In comparison, only about 6% of beds are currently used for Covid-19 patients.

The high occupancy rates are due to a combination of factors, including the broader respiratory virus season, seasonal flu, and a backlog of patients who delayed care during the pandemic. According to the US Centers for Disease Control and Prevention, all but six states are experiencing "high" or "very high" respiratory virus activity, with seasonal flu activity remaining high and continuing to increase. The number of people admitted to the hospital for flu during the week of Thanksgiving nearly doubled from the previous week, and this data likely does not reflect the full effects of holiday gatherings.

In addition to the influx of flu patients, hospitals are also facing workforce shortages and a backlog of patients who delayed care during the pandemic. About 10% of hospitals are reporting a "critical staff shortage," impacting their ability to provide care. Pediatric hospital beds have also been more full than usual for months, with about 76% of beds in use compared to an average of two-thirds in recent years.

The situation is particularly dire in Rhode Island, where more than 90% of hospital beds are in use. Eight other states—Washington, New Hampshire, Massachusetts, Minnesota, Georgia, Missouri, West Virginia, and Oregon—are also facing high occupancy rates, with more than 85% of beds full. These states are experiencing the combined effects of respiratory viruses, flu, and workforce shortages, putting a strain on their healthcare systems.

As hospitals adjust their bed capacity based on staffing and resources, the high occupancy rates highlight the ongoing challenges faced by the healthcare industry in the US. With more than 5,500 registered hospitals in the country, the current situation underscores the impact of the pandemic and the need for effective solutions to address bed capacity, staffing shortages, and patient care.

Flu and respiratory viruses causing high admissions

As of 2018, there were 5,534 registered hospitals in the US, with 4,840 defined as community hospitals. The nonprofit hospital share of total hospital capacity has remained stable at about 70% for decades.

Flu and respiratory viruses are a major cause of hospital admissions in the US. Respiratory syncytial virus (RSV) and influenza have both been blamed for hospital winter bed pressures. RSV is also a significant cause of illness in children, and there are now vaccines available for adults over 60, pregnant people, and infants and toddlers. In California, the state's new respiratory virus dashboard shows that hospital admissions for COVID-19 are similar to the previous year, while flu admissions are lower. However, flu and RSV activity is rising, and health officials urge extra precautions.

In a study of adult patients with acute respiratory symptoms, 435 patients were tested over two seasons. The combined results showed 14 cases of influenza A/H3N2, 14 cases of RSV A, and 6 of RSV B. Most patients were over 65, and most positives were found in this age group. In another study, respiratory viruses accounted for 15% of hospital admissions for respiratory infection.

While the rates of flu and RSV are on the rise, they are causing fewer hospitalizations than the previous year. The number of deaths from these viruses is also lower than the previous year.

Pediatric beds fuller than usual

As of 2022, hospitals in the US are fuller than they have been throughout the Covid-19 pandemic, according to a CNN analysis of data from the US Department of Health and Human Services. More than 80% of hospital beds are in use nationwide, up from 72% two weeks prior. Hospitals have been more than 70% full for most of the pandemic, and they've been 80% full at only one other point: in January 2022, during the height of the Omicron surge in the US. At that time, about a quarter of hospital beds were in use for Covid-19 patients, while now, only about 6% of beds are in use for Covid-19 patients.

The broader respiratory virus season is in full swing across the US. All but six states are experiencing "high" or "very high" respiratory virus levels, and seasonal flu activity remains "high and continues to increase," according to the US Centers for Disease Control and Prevention. The number of people admitted to the hospital for flu during the week of Thanksgiving was nearly double the number of admissions the week before. The latest surveillance data probably does not reflect the full effects of holiday gatherings, as it only captures data through November 26, two days after Thanksgiving.

Nancy Foster, vice president for quality and patient safety with the American Hospital Association, says that an influx of flu patients is a key reason why hospitals are filling up. In addition, workforce shortages and a backlog of patients who delayed care during the pandemic have contributed to the high hospital occupancy rates. About 10% of hospitals are reporting a "critical staff shortage."

Pediatric hospital beds have also been more full than usual for months. About 76% of pediatric hospital beds are in use, up from an average of about two-thirds full in recent years. RSV is filling pediatric beds, along with patients who are sicker now due to putting off care during Covid-19, which has required more intensive and complex care.

Staff shortages affecting bed capacity

Hospitals in the US are facing challenges due to staff shortages, which is affecting their bed capacity and ability to provide timely care. This issue is particularly evident in Massachusetts, where hospitals are experiencing a capacity crunch, with long waits in emergency rooms. Dr. Jason Tracy, vice president and chief medical officer of South Shore Health, confirmed that the hospitals are full, and staff shortages are a significant contributing factor. The closure of hospitals, such as Norwood and Brockton Hospital, has further exacerbated the problem, creating a backlog of patients waiting to be discharged. This, in turn, leads to longer wait times and affects the hospital's ability to admit new patients, particularly in emergency cases.

The Massachusetts Hospital Association has identified this backlog in patient discharge as the primary cause of the capacity crunch. The association's concerns are shared by healthcare providers and administrators alike, who acknowledge the urgent need to increase the workforce to address the capacity issues effectively. The situation in Massachusetts is not an isolated case, as hospitals across the US are facing similar challenges due to staff shortages, winter season demands, and other operational factors.

Staff shortages in hospitals have led to the unfortunate necessity of cutting services and laying off employees. For example, Homer G. Phillips Memorial Hospital in St. Louis cut jobs due to "ongoing business challenges" and blood supply shortages, which ultimately led to the hospital surrendering its license. Orlando Health is another example, where the planned closure of Rockledge Hospital and outpatient departments will result in the loss of 940 jobs, including essential medical positions. These layoffs affect a range of roles, from nursing and physician roles to administrative and support staff, impacting the overall functionality and capacity of the hospitals.

The situation is further complicated by the fact that, in some cases, hospitals are not just downsizing but completely closing down. For instance, the East Ohio Regional Hospital in Martins Ferry closed its emergency department, pharmacy, long-term care, and skilled nursing facility, resulting in the elimination of various jobs. Similarly, the United Medical Center in Washington, D.C., announced plans to close, laying off nearly 500 employees across different roles. These closures and job cuts significantly impact the bed capacity and overall healthcare services available to the community.

To conclude, staff shortages in US hospitals are having a direct impact on bed capacity and the timely delivery of healthcare services. The capacity crunch in Massachusetts, fueled by staff shortages and compounded by hospital closures and discharge backlogs, is a pressing issue that requires immediate attention. As hospitals strive to meet the demands of their communities, addressing staff shortages and ensuring adequate resources are crucial steps towards improving bed capacity and providing efficient patient care.

Backlog of patients who delayed care

The COVID-19 pandemic significantly impacted the continuity of healthcare services, with many appointments, treatments, and surgeries for non-COVID patients being delayed, resulting in a backlog of patients. This backlog has led to extended waiting times, reducing patients' quality-adjusted life years (QALY) gains over their lifespan as they have less time to benefit from the surgery.

During the pandemic, medical specialists had to prioritize certain patients due to reduced hospital capacity. This prioritization was based on various criteria and may not have been directly related to the potential QALY gains of those patients. As a result, the actual QALY losses may have deviated from the predicted mean QALY losses.

The impact of delayed care on QALY losses is challenging to estimate empirically, as it requires knowledge of patients' health status before and after the delay. In the absence of this data, assumptions are made based on the backlog size and average QALY gains from surgical procedures reported in the literature. However, these QALY values may not always be applicable to the diverse patient population, potentially leading to biases in understanding the real health impact.

To address the backlog and reduce waiting times, some weeks during the summers of 2020 and 2021 saw an increase in elective surgical procedures performed. This effort to catch up on delayed procedures resulted in additional surgeries being completed, mitigating some of the negative impacts of the backlog.

In the United States, the issue of delayed care is also influenced by the healthcare system. With a mix of nonprofit, privately owned for-profit, and government hospitals, the accessibility and affordability of healthcare vary. Factors such as insurance coverage, the availability of a usual source of medical care, and financial considerations can contribute to patients delaying necessary medical care.

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