Are NC hospital beds 'typically' 85% full?

Hospitals are preparing for an influx of patients as the novel coronavirus spreads across the U.S.

With that in mind, North Carolina state Sen. Jeff Jackson has tried to keep his constituents informed by posting on social media.

Jackson, a Mecklenburg County Democrat, regularly tweets stats about the pandemic. And on March 19, he urged people to reschedule elective procedures to free up space for coronavirus patients.

"Hospitals are starting to cancel elective surgeries and doing their best to empty hospital beds to prepare for a surge. Our hospital beds are typically 85% full across the state. If we don't significantly reduce that number within the next week, that's a major problem," Jackson tweeted.

Is it true that, under normal circumstances, hospitals operate at 85% capacity?

We couldn’t find a supporting number. But we did learn that it’s normal for NC hospitals to treat patients while their facilities are close to being full.

We reached out to Jackson about his tweet. He said he heard the figure from officials with North Carolina’s Department of Health and Human Services. So we reached out to them.

DHHS spokeswoman SarahLewis Peel responded by email, but didn’t give an exact number.

"On any given day, our hospitals — by design — operate at 90 to 100% capacity. That’s why we have sought waivers to allow critical access hospitals to operate above their licensed capacity," Peel wrote.

DHHS later clarified that those numbers are usually during flu season and that evidence is anecdotal. It’s from speaking with hospital managers and suppliers.

David Weber, the associate chief medical officer at UNC Health, told NC Health News something similar. He said that, with the closure and downsizing of many rural hospitals, there are fewer beds overall across the state.

"The U.S., compared to years ago, has less open beds and on a normal busy week, you know, most of our hospitals, including UNC, would be running between 90 and 100% occupancy," he said.

However, we need hard numbers -- not anecdotes -- to get the most accurate picture.  

So, what stats are available? The North Carolina Health Association had a lower estimate, but its latest figures are from 2018.

Cynthia Charles, the association’s vice president for communications, pointed to statistics from the U.S. Centers for Disease Control and Prevention. In 2015, the average US hospital occupancy rate was 65.5 percent.

"For North Carolina, (the) average hospital occupancy rate is 61% for 2018," she said.

Other estimates PolitiFact found put the average occupancy rate in the 60-to-75 percent range.

Charles noted that people may get different estimates depending on how they account for beds, among other things.

"There could be a difference in how they’re defining capacity, for example whether they are looking at licensed vs. staffed beds, or whether they are considering ‘current state’ staffing as capacity," she said.

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Mark Holmes, director of UNC’s Cecil G. Sheps Center for Health Services Research, agreed with Charles. Holmes said there are different ways to count beds and averages. Staffing levels could also come into play, he said.

Holmes and his colleagues recently analyzed cost reports filed to Medicare in 2018. Those numbers suggested a 58% occupancy average, he said. It’s likely that some small, rural hospitals bring down the statewide average.

"Some of our smaller hospitals are at less than 20%," he said. "But larger ones — like Duke and UNC— are indeed at 85% on average throughout the year."

The Sheps Center recently published a study of NC hospital occupancy rates.

Important final point: hospital capacity should not be viewed as the sole indicator of whether it can continue treating patients, Holmes said.

Hospitals need four things to properly treat patients, he said:

1. square feet 
2. a license from the government
3. equipment (including beds), and 
4. qualified staff.  

Hospitals may face limits in terms of square footage, Holmes said. But some government agencies are relaxing those regulations and hospitals are creating space where they can, such as dormitories.

Indeed, Weber said UNC Health is shifting its units around and even using tents outside to triage and treat people with ailments that aren’t as serious as COVID-19.

"So the square feet and licenses are less important than, in general, the attention they often receive," Holmes said in an email. "Most people who study this issue think the biggest limitations to capacity are equipment— e.g. ventilators — and qualified staff, especially as the epidemic infects staff and their family members."

Jackson said North Carolina’s hospital beds "are typically 85% full across the state."

The way he worded his tweet makes it seems like all hospitals are usually at 85% capacity. That’s not right. It depends on the hospital and it depends on the season. 

But he has a point that many of North Carolina’s hospitals routinely treat patients while their facilities are close to maximum capacity. So we rate his claim Half True.