As the first dose of Covid-19 vaccine was delivered at a Los Angeles-area hospital, the county’s hospital and ICU capacity dropped to alarming lows.
According to Dr. Christina Ghaly, director of L.A. County Health and Human Services, there were only 370 available hospital beds in county-run hospitals. ICU availability was even worse, with just 56 adult ICU beds remaining. That is only the second time availability has dipped below 100, she said.
There were more beds available in non-county hospitals, but those numbers were not immediately available.
Orange County on Monday set new records for new coronavirus diagnoses — 3,250 — and hospitalizations, with the county’s adjusted intensive care unit capacity reaching zero. While that capacity was about 11% over the weekend, it has obviously since fallen. And the adjusted rate filters out capacity such as NICU beds for children. For comparison, Orange County’s daily positive case count was 1,056 on November 29, so the daily umber has risen over 200% in just 2 weeks.
Southern California as a whole on Monday only had 2.7% of its ICU bed capacity remaining, according to state figures.
Los Angeles County reported 7,344 new cases on Monday. L.A. County Public Health Director Barbara Ferrer said the number of new cases is artificially low, due to a lag in reporting of weekend test results from one of the largest processing labs. She says that lag means that Tuesday will likely see an unusually large number of new cases. Between November 1 and December 7, cases in Los Angeles County increased by 625%, said Ferrer. And, she added, cases have swelled further in the past week.
There are 4,203 people hospitalized with COVID in the county, and nearly half of the county’s ICU beds are now occupied by COVID patients. Ferrer says the county will likely have 5,000 people hospitalized with COVID-19 by the weekend.
New Cases: 7,344 (532,730 to date)
New Deaths: 48 (8,345 to date)
Current Hospitalizations: 4,203 pic.twitter.com/BEosrV3xcL — LA Public Health (@lapublichealth) December 14, 2020
Ghaly noted that the county has been able to add 13% more ICU beds now in comparison to summer peak. But, she said, “That durability is not infinite. We cannot maintain this rate of increase. We will physically exhaust ourselves.”
She said that one way hospitals are accommodating the Covid spike is by canceling elective procedures. “Hospitals have started to some extent to curb non-essential proceeders,” she said.
Another method of regulating bed capacity is “diversion,” in which an ambulance is diverted to a hospital — possibly farther away — that has more beds. “We are aware that there are certain hospitals in the county where offload time can exceed four hours,” revealed Ferrer. “That’s why we need the diversion system.”
On Sunday, a day when emergency departments are traditionally not as busy, 81% of the 911-receiving hospitals in L.A. asked to have advanced-life-support ambulance traffic diverted to other medical facilities due to overcrowded ERs. The average of hospitals requesting diversion this time of year is normally 10% to 15%, Ghaly said last week.
The next step for local hospitals, said Ghaly, would be to “break ratio,” or implement team-based nursing. The state mandates nurse-to-patient ratios, but in emergency situations the number of nurses per patient can be lessened.
The state has offered two separate waiver processes, said Ghaly. L.A. County hospitals have not broken ratios yet. But, said Ghaly, a number of local hospitals have already applied for and received waivers should staff need to deploy them.
Patient-to-doctor ratios are “important, and breaking them can lead to sub-optimal outcomes,” warned Ghaly.
City News Service contributed to this report.
Undaine on December 15th, 2020 at 15:00 UTC »
Here now, ICU in South LA.
This “x amount of icu beds left in LA” is a misnomer. They’re all gone and have been for a week. There might be 50 unoccupied beds, but it’s either there’s not enough staff to fill them or they’re only empty to be cleaned for the next person to come die in.
3 people died tonight in my hospital. We have 20 beds in our ICU and I’ve got 2 intubated covid pts to watch over. The ED is broken, we’ve doubled up all the rooms and people are just lining the hallway. One nurse has all our psychs out in two tents, male and female. Her ratio right now is 16:1. 4 is supposed to be the max.
One person has been in the ED for 207 hours. The hospital is that full.
Many of the staff are out sick with covid.
We got rid of all OR cases. Our PACU is now a ward of ICU covid pts, ratios are 3:1 up there with one RN floating to help. I was there the first night they opened it, I worked for 14 hours straight with no break. I had to wear full PPE the whole time because all the covid pts are on high flow o2 and there are no doors, just one big room. I didn’t get any breaks. There was no bathroom. One of those patients died today. His family couldn’t visit him.
We are all extremely burnt out from 9 months of this.
Please please please get the vaccine as soon as you can, I get mine on Wednesday.
emjejO7 on December 15th, 2020 at 14:48 UTC »
Critical Care Float nurse here. I’m currently working at a hospital in LA county. Our ICU was at capacity over the weekend, so I was holding (taking care of) two patients waiting for ICU beds in the Emergency Department. They both waited over 24 hours. They have shut down PACU and any non-emergent surgery to turn that unit into an overflow ICU.
My current schedule is working 5 shifts/week instead of 3, because there isn’t enough nurses to man the ICI overflow.
Yet my concern is for those non-covid related admissions who have a delay of care because we are over-saturated with COVID-19 patients. For example, we are not a Comprehensive Stroke Center, and do not have a neurosurgeon at our hospital. On Saturday night I received a woman who had stroke symptoms, imaging of the head showed she was having a hemorrhagic stroke (brain bleed). Our hospital would typically immediately transfer this woman to a comprehensive center that had a neurosurgeon, but all the hospitals from LA to Las Vegas who could take her are full. Took until Monday evening to get her to a hospital that could actually help her. But that time her neurological exam had worsened and she had a midline shift of 6mm (her brain was being compressed and damaged by the pocket of blood stuck in her skull). Her care was delayed because of COVID...smh
Edit: imaging
Edit 2: mm
Quesadilla2022 on December 15th, 2020 at 12:54 UTC »
Remember, "if we build it, they will come" is not the solution. We can make as many beds as we want, even bust out some couches if need be.
The issue is throughput with doctors, nurses, therapists, etc with ICU experience. We don't have enough.
The term '% of ICU beds' refers to operating capacity, not physical number of beds.