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What Happens When the ICU Fills Up

Kelsey Tyler

Your loved one needs urgent care for a heart condition that’s flared up. When the ambulance arrives, you learn that instead of heading to your local hospital’s intensive care unit — which is at capacity because of an influx of COVID-19 patients — they’ll be rushed to a different facility a few counties away. 

It’s not a typical scenario, but it’s one that some patients are now experiencing as ICUs across the country fill up because of surging coronavirus cases. In late July, for example, hospitals in Florida’s Miami-Dade County were reportedly operating at 146 percent capacity. ICUs in Georgia, Texas, Louisiana and South Carolina have also recently either reached capacity or seen diminishing capacity.

ICU beds in coronavirus hotspots have filled up with patients who’ve deteriorated after contracting the virus and need round-the-clock, complex care. When this happens, fewer traditional ICU spaces are left for people who’ve had heart attacks or strokes or been in car accidents, and hospitals have to find other beds for them. Care for patients without urgent needs can also be disrupted, with procedures delayed.

“When a hospital’s ICU is at capacity, hopefully most patients will not see a difference,” says Dr. Jaspal Singh, a critical care physician in Charlotte, North Carolina. “We haven’t stopped doing cancer surgery, stroke or heart disease care. But when you’re at capacity, you can only do so much. Priorities change. Be prepared for things looking a little bit different.”

Here’s what to expect if you or your loved one needs care at a hospital that’s at ICU capacity because of COVID-19.

What kinds of changes do hospitals make when their ICU is at capacity?

An efficient hospital operates at around 85 percent capacity in normal times, says Dr. Ann Weinacker, associate medical director of the intensive care units at Stanford Health Care. When capacity hits 100 percent, hospitals can turn other areas into ICU units, provided they have the necessary extra equipment, like monitors and ventilators. “There does become a point where we outstrip all the resources,” says Weinacker

At the height of New York City’s spring COVID-19 surge, New York Presbyterian Hospital put ICU beds in operating rooms. Some hospitals at capacity hire extra ICU staff to help out, but others pull nurses without extensive ICU experience from other parts of the hospital to pitch in. Hospitals at capacity are also less likely to accommodate special requests. If, for example, you always take your mother to a specific hospital for care when her chronic health issue flares up, that might not be possible if a facility is at ICU capacity. “Family requests may not be honored,” Singh says.

If I need urgent care, is there a chance my local hospital won’t be able to take me?

Yes. While it’s rare, if a hospital is at ICU capacity and areas that it’s converted into extra ICU space are also full, you might be sent to another hospital for care. Singh recently had to send a critically ill patient across state lines to a facility with space. The problem can be more pronounced in rural areas, which typically have fewer hospitals than urban areas. A recent report from the Society of Critical Care Medicine found that just 1 percent of America’s ICU beds are in rural areas. The patients I most worry about are those who live in rural communities,” Singh says.  

What else might happen at the hospital that’s different?

After observation in the ER, a patient with a serious but not critical condition might be sent home for monitoring, whereas before COVID-19, they might have stayed in the hospital overnight. That could happen, for example, if a patient with COPD, a chronic inflammatory lung disease, comes down with a viral illness that’s not COVID. They might be sent home with a pulse oximeter to monitor their oxygen and an oxygen tank. 

If you’re in a COVID hotspot, you also might not be able to enter the hospital with your loved one when you arrive. Most hospitals, however, make exceptions for patients who have cognitive disabilities or those who are in critical condition. 

In general, don’t be surprised if visitor policies change overnight. Stanford stopped allowing visitors as the pandemic escalated, but then relaxed its policy to permit two visitors as conditions improved. Now with COVID-19 cases rising again, only one person can visit each day per 12-hour period, says Weinacker.

What if I have elective surgery planned?

You might get a call that your elective surgery has been postponed. In Texas, Gov. Greg Abbott banned elective medical procedures in more than 100 counties to free up hospital resources as COVID-19 cases escalated in the state. Noncritical surgeries or procedures like knee replacements or colonoscopies will likely be put on hold as hospitals put all resources toward COVID and other critical patients. Another reason for hospitals in a hotspot to postpone elective procedures is to keep otherwise healthy patients from being exposed to the coronavirus, says Weinacker.

With hospitals at capacity, what can I do to make the experience a smooth one for myself or my loved one?

Because you or your loved one might end up in an ICU where non-ICU nurses or even non-ICU physicians are working, it’s a good idea to be fully up to speed on the condition that’s brought you to the hospital and on the standards of care, Singh says. That means knowing best practices in terms of procedures or medications. “Patients and families may need to advocate more,” he says. 

If you have permission to access your loved one’s medical records, do that too, he adds, and get involved in looking at any labs. Doctors and nurses will likely be stretched thin and not have much time to talk. “If you can’t access caregivers directly, at least you can look at the notes through the patient portal,” he says.

Should I be afraid to go to a hospital that’s at capacity because of COVID?

No. Many conditions can get worse if you don’t seek medical care quickly. “People have stayed away from the hospital, and they’ve had worse outcomes as a result,” Weinacker says. Instead, don’t ignore warning signs of illness. “Be early and proactive,” says Singh. “Talk to your regular doctor and specialists. Seek them out before things get bad.” 

If you or a loved one does need to go to the hospital, expect to be screened at the door for any COVID-19 symptoms. Visitors who seem sick will be turned away. If you’re allowed in, prepare for limited seating in public areas and expect to wear a mask at all times.

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