Expanding Hospital Capacity: The Time to Act is Now

Gregg Miller , MD

Chief Medical Officer

Published March 31, 2020

Expanding Hospital Capacity: The Time To Act Is Now

After weeks of bad news about the COVID-19 pandemic, we may be seeing a silver lining in Washington State. Data suggests that the curve may be flattening in the Seattle area, the first area in the United States to report both COVID-19 cases and deaths. While new cases are still rising, they’re growing more slowly than in other areas of the country. This is likely due to the early implementation of public education and physical distancing measures sparked by those first cases.

While this is great news, there’s always the possibility that this plateau could be a temporary hiccup on a steeper curve. Across the region, hospitals are continuing to prepare for a potential spike in cases by taking steps to expand our ED, inpatient, and especially our ICU capacity. Here’s a look at some of the actions we’ve taken that can serve as a blueprint for other regions:

Emergency Department

The ED represents the hospital’s front line for COVID-19 response. As such, one of our first priorities has been to preserve capacity. One key way we do this is by keeping “not sick” patients (including those with COVID-19 symptoms) out of the ED.

To help us out, health systems have implemented online screening tools. By asking a few simple questions, these tools identify people who should seek further care or testing for COVID-19 and directs them to contact their primary care provider. It also provides every visitor with resources to help them stay safe and informed during the outbreak.

Another step we took to relieve pressure on the ED was to establish community clinics as alternative screening locations. This allows patients with mild symptoms and a doctor’s order to get tested outside the hospital.

We have mapped out new patient flow protocols for potential COVID-19 patients, including separate locations for screening, waiting, testing, and treatment. When possible, we use teleconferencing or even just regular phone calls to communicate with patients in order to protect staff and preserve PPE. This works for screening patients in their cars and even from just outside the door to the patient’s room. A shorter in-person visit by fewer people reduces risk of transmission AND saves on PPE.

Inpatient Capacity

Today, hospitals in Seattle are near 100 percent inpatient capacity. But the truth is that today’s 100 percent capacity is higher than it was just a month ago because of the rapid transformation our community made early on in this pandemic:

Postponing most elective surgeries to free up inpatient beds and staff and conserve PPE.
Identifying and converting contingency areas (unused clinical space, lobbies, etc.) for a surge.
Designating areas where COVID-19 patients can be isolated or cohorted within the hospital.
Promoting workplace safety, including infection control and proper use of PPE.

Hospitals across the region as well as our public health authority are coordinating care and sharing resources. An example of coordination in action: my hospital is in the process of converting its birthing center and level II NICU to an ICU for future COVID-19 patients. One of our sister hospitals is opening its birthing center to our obstetrics patients. Staff are currently contacting patients to discuss alternatives and ensure a smooth transition.

Early preparation is crucial

The experience of New York City’s beleaguered hospitals underscores the importance of expanding ED, inpatient, and ICU capacity immediately (if not sooner). By the time a surge is upon you, you will be scrambling to respond effectively.

So please err on the side of caution. This article describes efforts initially taken by Seattle-area hospitals to prepare for the surge of COVID patients. Hospital and clinical leaders need to overprepare to the extent possible. We can hope your efforts will be for naught. But they are more likely to save thousands of lives.

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