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Hospitals Have Less Capacity Than Missouri’s COVID-19 Website Shows, Federal Data Indicate

Intensive Care Unit hospital beds occupied with COVID patients in Missouri are ending the month at nearly 74 percent capacity and climbing.
Photo Illustration-Carlos Moreno/KCUR 89.3-AP Photo/Rick Bowmer
Federal data suggest that Missouri is overestimating its hospital capacity.

Some doctors say Missouri's official hospital capacity data is exaggerated because it includes beds that aren't staffed by health care workers.

Missouri hospital officials have been warning this week that their facilities are running low on space as the number of COVID-19 patients in the state hits its highest level so far.

Although Gov. Mike Parson and the state’s COVID-19 dashboard suggest that plenty of hospital space remains, newly updated federal data and the state hospital association undermine that contention.

Missouri saw continued increases in COVID-19 hospitalizations this week, with the number of patients hospitalized with the novel coronavirus jumping to a record high 1,612 people on Thursday, according to state data.

Doctors at the University of Kansas Hospital, which serves patients from both Kansas and Missouri, said on Thursday that they had opened an overflow intensive care unit to cope with the unprecedented numbers of patients they've admitted.

Parson, however, stood by his claim that hospitals are managing the record numbers.

“I want to assure you that overall, our health care system is STILL meeting the demand,” Parson tweeted on Thursday.

As of Tuesday, the most recent day for which complete hospitalization data is available, the COVID-19 dashboard maintained by Missouri's health department showed a total of 2,794 intensive care units throughout the state, with 1,883 of those units occupied by patients. That leaves only one third of the total supply available for use. COVID-19 patients accounted for 479 of the ICUs occupied, according to the dashboard.

But federal data contradict those numbers. According to an update provided on Friday by the Department of Health and Human Services, the state has just 78% of the total ICUs shown on the dashboard on Tuesday.

The federal data also show fewer hospital beds than reported by the state. While the state’s dashboard said there were a total of 21,495 hospital beds, the federal database estimates the state had only 17,986 beds available.

The discrepancy may be due, at least in part, to differences in how available beds and ICUs are defined.

Missouri Department of Health and Senior Services spokeswoman Lisa Cox said that for its dashboard, the state uses the HHS definition of "All Hospital Beds," which may include staffed inpatient beds and outpatient beds as well as overflow, observation and surge beds.

The "inpatient beds" listed on the database updated on Friday include only staffed beds that are used by people admitted to hospitals.

Cox said the state health department was not aware of the federal ICU database. But she insisted the capacity numbers do not reflect the overall state of hospital capacity.

“Total hospital bed capacity is only one measure of potential strain on a facility and should be taken in context,” Cox said in an email. “We work with [the Missouri Hospital Association] and with hospital systems on an ongoing basis to understand all aspects of strain, including staffing, bed type, supplies, and other factors.”

But Missouri Hospital Association spokesman Dave Dillon said the association would be changing to a “staffed bed” model of reporting, which would be closer to what the federal database numbers show.

“This reflects our work with hospitals to move the definition to exclusively staffed beds,” Dillon said in an email. “This should provide a more precise understanding of capacity as hospitals transition this week and into next.”

Kansas City area hospitals officials said the capacity reflected in official state data can appear larger than what’s actually available because it doesn’t account for staffing

“A real problem that I think the area hospitals are having, based on my calls, is being able to staff all the beds that we actually have available,” said Dr. Mark Steele, chief medical officer of Truman Medical Centers.

Some hospital workers, meanwhile, say the additional burden of soaring hospitalizations has fallen on their shoulders.

Several nurses contacted KCUR this week about hospital conditions. They asked for anonymity due to concerns about losing their jobs.

“Administration changing our 3:1 patient ratio to now have 4:1 critical care patients,” one ER nurse wrote. “We are only human. We cannot be in 6 places at once. I am not able to be the best nurse and patient advocate because I don’t have the time anymore!”

And an ICU nurse said their hospital was often short-staffed and many skilled nurses had left their jobs.

Steele acknowledged that medical staff were being asked to take on additional work and facing unusually difficult situations.

“With COVID, it clearly has added some stress and challenge to our system,” he said.

Some Kansas City area hospitals have had to redirect ambulances and decline transfer patients for brief periods in recent weeks. Such actions are not unusual during busy periods, and hospital officials say the hospital system is stable and able to provide care for those who need it.

Hospitals can also add supplementary staff, and Steele said Truman had relied on such “agency” staffing to fill gaps. But he said the pandemic made that challenging due to the high level of skill needed to treat critical COVID-19 patients.

Dillon, of the hospital association, said continuing changes to hospital reporting requirements have been challenging and that many of the differences in the federal, state and hospital association data remain unclear.

“While we continue to refine the numbers and definitions to reflect the status of hospitals in Missouri, we can only explain what is going on with our analysis,” Dillon said.

As a health care reporter, I aim to empower my audience to take steps to improve health care and make informed decisions as consumers and voters. I tell human stories augmented with research and data to explain how our health care system works and sometimes fails us. Email me at alexs@kcur.org.
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