Bloomington-Normal has just over two hospital beds for every 1,000 people. In terms of bed capacity, the Twin Cities ranks among the lowest of any major metro area in Illinois.
That sounds like a worrisome metric. But is it?
Seth Trueger is an emergency room physician and spokesperson for Illinois Medical Professionals Action Collaborative Team (IMPACT), an advocacy group for health care workers. He said capacity in Bloomington-Normal is roughly on par with larger metro areas in Illinois, like Chicago.
Trueger said, in fact, capacity across the country falls well below the five beds per every 1,000 people recommended by the World Health Organization.
And although that may sound like a concerning statistic, Trueger said it doesn’t tend to present a problem day-to-day.
“In normal times, our ICUs are basically always full,” he said.
Trueger said it may come as a surprise to people outside of the health care industry, but hospitals tend to work at or near capacity for a variety of reasons. Hospitals work around those high numbers by creating “slack” in their systems that allow for a higher influx of patients when necessary.
He said the pandemic offered a perfect example of those flexible systems when hospitals cancelled or postponed elective surgeries to make room for COVID-19 patients.
And even though it might sound counter intuitive, Trueger said that according to a principle called Roemer’s Law, fewer overall hospital beds actually can be a good thing.
“Roemer’s Law says that in an insured population, any hospital space will be used. Because you’ll find some way to use it.”
Trueger said the adage is a little tongue-in-cheek, but points to the reality that any bed added to a hospital tends to get used. Less bed capacity could translate into lower overall health care costs as hospitals shift to more preventative medicine and wellness-based compensation models — things that could prevent patients from needing a bed in the first place.
Lynn Fulton, president of OSF Healthcare, said that shift already is happening. And along with advances in treatment options, she said hospitals are naturally moving toward fewer beds.
These days, hospital stays are no longer required for things like tonsil surgery. Tonsil removal used to land patients in the hospital for up to a week, but now it’s an outpatient procedure that can be completed in an ambulatory center.
“That has been the case with, honestly, many procedures that used to necessitate a long hospital stay and are now being done on the outpatient side,” said Fulton, adding the same can be said for many illnesses.
“Today we’re able to treat those so well on an outpatient basis that patients are able to stay home,” she said.
Some healthy patients can even be out the door hours after procedures like knee replacements or heart ablations. Fulton said that wasn’t the case even a few years ago.
Surging need
The challenge for hospitals comes when the need for beds suddenly surges as it has throughout peak times during the pandemic. To handle the demand, some hospitals in larger cities had to resort to measures like converting convention centers into field hospitals.
“But I think that is the exception, not the norm,” Fulton said. “The importance is what is the scalability, and what is your ability as a hospital — as well as a system — to be able to pivot.”
"My bigger concern as a healthcare administrator is not necessarily the beds, but the caregivers we place at those bedsides."Tim Bassett, Carle BroMenn Medical Center
Fulton said hospitals build flexibility into their systems so capacity can be scaled up or down depending on need. She said they drill regularly for events that could cause a large number of people to need emergency medical attention at the same time — like bus accidents or tornadoes.
“And sometimes that means using parts of our hospital in different ways than what we do under normal operations,” she said.
Hospitals also work together on surge planning, and across networks to address situations that may require a high number of beds. Tim Bassett, vice president of operations at Carle BroMenn Medical Center, said Carle works with community partners, including OSF, to create additional beds as needed.
Bassett said that when it comes to potential vulnerabilities in hospital capacity, beds aren’t really the problem.
“My bigger concern as a health care administrator is not necessarily the beds, but the caregivers we place at those bedsides," he said.
Staff trauma
As COVID hospitalizations peaked around the country during parts of the fall and winter, many areas did experience shortages of health care workers. Bassett said while that hasn't played out on the same scale in Bloomington-Normal , area staffing has been strained at points throughout the pandemic.
That can lead to concerns that are harder to quantify.
“I get concerned about the trauma that our caregivers have experienced, and how that takes a toll on them personally,” Bassett said.
As active coronavirus cases in McLean County begin to climb yet again, that strain isn’t letting up.
“We’re revisiting some of the same issues, unfortunately, that we had to address earlier on, 12 — even 18 — months ago,” Bassett said.
He summed up the sense of the situation as "deja vu."
