Warwick Medical School, University of Warwick, Coventry, UK
The Alan Turing Institute, London, UK.
BMJ Open. 2021 Jan 26;11(1):e042945. doi: 10.1136/bmjopen-2020-042945.
In this study, we describe the pattern of bed occupancy across England during the peak of the first wave of the COVID-19 pandemic.
Descriptive survey.
All non-specialist secondary care providers in England from 27 March27to 5 June 2020.
Acute (non-specialist) trusts with a type 1 (ie, 24 hours/day, consultant-led) accident and emergency department (n=125), Nightingale (field) hospitals (n=7) and independent sector secondary care providers (n=195).
Two thresholds for 'safe occupancy' were used: 85% as per the Royal College of Emergency Medicine and 92% as per NHS Improvement.
At peak availability, there were 2711 additional beds compatible with mechanical ventilation across England, reflecting a 53% increase in capacity, and occupancy never exceeded 62%. A consequence of the repurposing of beds meant that at the trough there were 8.7% (8508) fewer general and acute beds across England, but occupancy never exceeded 72%. The closest to full occupancy of general and acute bed (surge) capacity that any trust in England reached was 99.8% . For beds compatible with mechanical ventilation there were 326 trust-days (3.7%) spent above 85% of surge capacity and 154 trust-days (1.8%) spent above 92%. 23 trusts spent a cumulative 81 days at 100% saturation of their surge ventilator bed capacity (median number of days per trust=1, range: 1-17). However, only three sustainability and transformation partnerships (aggregates of geographically co-located trusts) reached 100% saturation of their mechanical ventilation beds.
Throughout the first wave of the pandemic, an adequate supply of all bed types existed at a national level. However, due to an unequal distribution of bed utilisation, many trusts spent a significant period operating above 'safe-occupancy' thresholds despite substantial capacity in geographically co-located trusts, a key operational issue to address in preparing for future waves.
本研究描述了 COVID-19 大流行第一波期间英格兰床位占用情况的模式。
描述性调查。
2020 年 3 月 27 日至 6 月 5 日期间英格兰所有非专科二级保健提供者。
具有 1 型（即 24 小时/天，顾问主导）急诊部的急性（非专科）信托（n=125）、南丁格尔（野战）医院（n=7）和独立部门二级保健提供者（n=195）。
使用两个“安全入住率”阈值：皇家急诊医学院规定的 85%和 NHS 改善规定的 92%。
在高峰供应时，英格兰有 2711 张额外的机械通气兼容床位，反映出容量增加了 53%，入住率从未超过 62%。床位重新配置的结果是，在低谷时，英格兰有 8.7%（8508 张）的普通和急症床位减少，但入住率从未超过 72%。英格兰任何一家信托机构最接近普通和急症床位（高峰）容量满负荷的是 99.8%。对于机械通气兼容床位，有 326 个信托日（3.7%）的床位使用率超过 85%的高峰容量，有 154 个信托日（1.8%）的床位使用率超过 92%。23 家信托机构累计有 81 天达到其高峰呼吸机床容量的 100%饱和（每家信托机构的中位数天数=1，范围：1-17）。然而，只有三个可持续性和转型伙伴关系（地理上相邻信托机构的集合）达到了机械通气床位 100%的饱和。
在大流行的第一波期间，全国各级各类床位供应充足。然而，由于床位利用的分布不均，尽管地理上相邻的信托机构有大量的容量，但许多信托机构在相当长的一段时间内床位使用率超过了“安全入住率”阈值，这是为未来的浪潮做准备时需要解决的一个关键运营问题。
