US ICUs Experienced ‘Load Imbalance’ During Pandemic

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To decrease hospital strain and overloaded capacity, and support those groups who are affected, researchers suggest the need for enhanced efforts at the regional and state levels to coordinate transfers and balance load across hospitals.

More than half of the hospitals in the United States experienced intensive care unit (ICU) “load imbalance,” or overloaded capacity, while others in the market were under capacity during the COVID-19 pandemic.

Prior to COVID, reports have revealed that increased hospital and ICU capacity strain was associated with higher rates of adverse patient outcomes and increased mortality.

In efforts to examine the prevalence of load imbalance and the characteristics of hospitals most affected, researchers of a recent cross-sectional study published in Health Affairs mainly analyzed data from a COVID-19 Reported Patient Impact and Hospital Capacity file by the U.S. Department of Health and Human Services (HHS).

The file provides weekly hospital-level data on inpatient use and COVID-19-related admissions for all hospitals that were registered with the Centers for Medicare and Medicaid Services (CMS) as of June 2020.

From July 2020 to March 2022, 290 hospital referral regions (HRRs) were observed. It was found that ICU load imbalance was common during the pandemic, and that 53.1% of HRRs experienced load imbalance for at least one week.

Load imbalance peaked nationally during the week of Sept. 10, 2021, where 28.3% of the HRRs had an ICU strain or experienced high levels of ICU use.

At a point where load imbalance was at its highest, data shared 11.4% of HRRs had more than 10 beds that could have been transferred to hospitals with available bed capacity.

In addition, imbalance disproportionately affected HRRs with a higher proportion of Black residents and hospitals with a higher proportion of Medicaid-enrolled and Black Medicare patients.

HRRs in the South also had load imbalance at more than 20% of weeks than those in the other portions of the U.S, according to the study.

These findings contribute to the impact the pandemic had on Black people, who were 2.1 times more likely to be hospitalized and 1.6 times more likely to die because of COVID.

To decrease hospital strain and support those groups who are affected, researchers suggest the need for enhanced efforts at the regional and state levels to coordinate transfers and balance load across hospitals.

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