In the ongoing debate of “how stressed out is healthcare” I am seeing a lot of questions about what hospital capacity really means.
The best way to think about hospital capacity is to compare it to Thanksgiving dinner. Let’s say that I’m planning on Thanksgiving dinner for 8. That’s what my table seats and that’s how much food I made. At 8 people, I am “at capacity.” But what if 2 extra people show up? I can probably scoot the place settings closer together and fit 10. What if 2 additional people stop by? Maybe I can also fit 12 if we’re willing to get pretty cozy and I’m willing to utilize the kiddie table I have stored in the back. Even if I can find a way to fit 12 people at my table, I was still at capacity at 8.
12 people is possible just like it’s possible to fit 2 people per room in the ICU or start utilizing areas of the hospital for different purposes (like putting adults in pediatric rooms). However, 12 people aren’t necessarily going to have the same experience as 8 would. There won’t be as much food to go around so people won’t leave hungry, but they may not be full. If they want refills on their drinks, there may be delays since instead of 1 host per 8 people now it is 1 host per 12.
Unfortunately the outcomes in healthcare aren’t as benign as waiting to have your water refilled. Being stretched beyond normal capacity in healthcare means people being transferred to other facilities further from home. It means your outcomes like length of stay and mortality may worsen as you push to take care of surge populations.
Eventually there comes a point where you can’t stretch anymore. It’s sometimes hard to predict what resource will break first. For a while at the beginning it looked like it might be supplies like ventilators and PPE. Currently, the limiting factor is often staff. It doesn’t matter how many tables and chairs you have if there is no one there to cook the food and serve it.
In short, hospitals can and have been operating at capacity but can also still find a way to exceed that capacity for emergent needs. Seeing them operate at beyond capacity because it is their mission to care for you doesn’t mean they weren’t at capacity before.
(Of course this is all referencing total capacity and doesn’t get into the additional complexity of capacity for different types of beds (floor vs stepdown vs ICU). This also doesn’t discuss the ebb and flow of hospital census and how discharges at one point in the day may give you temporary capacity to fill back up for a brief window.)