HCA Healthcare’s Dr. Michael Schlosser, National Group chief medical officer and vice president of clinical excellence and surgical services, discusses innovative modeling aimed at increasing intensive care unit (ICU) capacity during COVID-19.
We’ve all seen the graph that illustrates the importance of “flattening the curve.” The graph contains two curves – a tall, sharp curve of cases without protective measures, and a lower, flatter curve of slows the spread through measures such as social distancing.
But there is a third line on that graph – a straight line that measures “health system capacity.” That’s the line that HCA Healthcare has the most ability to influence. This line measures the number of coronavirus cases that our health system can handle without becoming overwhelmed.
While all Americans are working to flatten the curve, HCA Healthcare is working to raise the line.
At first, that seems counter-intuitive. But there are things hospitals can do to increase their capacity – even their capacity of intensive-care unit beds. And thanks to our learning health system, HCA Healthcare is deploying its scale and skill to deliver the best possible health outcomes in the midst of a fast-developing, ever-changing pandemic.
HCA Healthcare was one of the first hospital systems in the United States to experience the effects of COVID-19. Our hospitals in San Jose, California began confronting this pandemic nearly a month before other hospitals and localities in the nation. We learned valuable lessons about social distancing and threat mitigation. For example, limiting physical access to the hospital was effective in mitigating community spread. Closing points of entry, posting additional security guards and reducing the flow of visitors helped immensely.
Our experience in San Jose provided us with real-time data, which the data analytics team spun up within a week into an enterprise wide predictive analytic tool to predict how many cases a hospital is expected to get, as well as the speed and severity of the outbreak. This told us we needed more ICU beds. We quickly converted 44 beds from a medical unit to meet the anticipated wave of patients.
HCA Healthcare has now developed a calculator for use in all of our hospitals. The calculator uses such variables as CDC estimates about transmissibility of the disease, the average daily patient population under normal circumstances, the population of the area surrounding the hospital, the current speed of transmissibility (are we on an Italy trajectory, a South Korea trajectory, etc.) and the current level of mitigation taken in a jurisdiction (social distancing, closure of bars/restaurants, shelter in place, etc).
Based on these analytics, we can estimate how many ICU beds will be needed across our system. Our hospitals are already identifying rooms that are prime candidates to be converted into additional ICU capacity – if and when they are needed. Certain criteria make a room a good candidate for conversion — small rooms with limited access (to limit community spread) plus rooms with sufficient infrastructure to support ventilators.
HCA Healthcare has always been proud of our mission. Above all else, we are committed to the care and improvement of human life. This challenge is no different. As a learning health system, we use our data to conduct research and create innovative tools that improve patient outcomes. We are working around the clock to increase our capacity in order to handle the influx of patients. There has never been a more important time to be working in our profession.
Dr. Michael Schlosser, MD
Chief Medical Officer, National Group
Vice President of Clinical Excellence and Surgical Services