Variances in the reporting of ICU bed counts from different sources are creating uncertainty regarding the severity of the situation in hospitals across the area. Mayor Eric Johnson in particular continues to tweet numbers for available ICU beds that are significantly higher than other sources.
“Does anyone there have an explanation for why @Johnson4Dallas's hospital stats say there are over 100 icu beds available, but @JudgeClayJ says it's like 20? This is very confusing and readers might like to know why,” Jeff Helfrich tweeted on Jan. 3.
The gap in ICU bed numbers between those shared daily by Johnson and other sources is significant. Over a six-day period recently, Johnson’s available ICU bed count was an average of 168 beds more than what Dallas County Judge Clay Jenkins reported.
As of Jan. 8, Johnson said 165 ICU beds were available in the city while Jenkins reported just 15 in the entire county.
Johnson’s data is also contradicted by numbers from the Texas Department of State Health Services' dashboard, which shows just 46 available ICU beds for region E as of Jan. 11, an area that includes Dallas and most of North Texas. The same day, Johnson tweeted that over three times that number of ICU beds were available in Dallas alone.
The variance has two main causes: differences in what is being reported and differences in the consistency of reporting.
Johnson’s numbers appear to include a large set of beds that are not counted by other sources. His spokesman Tristan Hallman said Johnson’s count pediatric ICU beds as well as a number of ICU beds at hospitals that are unlikely to be used by COVID-19 patients, such as those at a spinal trauma center.
“We are constantly full and have to place our patients in other floors where they don’t belong, therefore not getting the best quality care they need.” – anonymous Dallas hospital nurse
In contrast, Jenkins only shares available and fully staffed adult ICU beds and excludes pediatric, neonatal and mental health ICU beds that adults with COVID can’t use.
Hallman defended the inclusion of pediatric beds. That measure was included early in the pandemic when programs in other parts of the country were temporarily reconfiguring children's hospitals to accept adult COVID-19 patients. “When we set this up, the idea was to look at the aggregate capacity of our hospitals… If you look at other spots around the country, children’s hospitals have turned pediatric beds into adult beds,” Hallman said.
Despite record-breaking daily cases of COVID-19 hospitalization, pediatric ICU beds have yet to be converted in significant numbers here.
The second reason the mayor’s ICU count may be higher is the fact that all of these numbers are based on different sources of data. Johnson receives his data directly from 25 local hospitals, while Jenkin’s numbers are sourced from the North Central Texas Trauma Regional Advisory Council, which reports on an unspecified number of hospitals across the North Texas area. The state’s dashboard numbers are sourced through a separate process.
Hallman said the inconsistencies in reporting by some major hospital systems at the state level and regional level has likely contributed to the gap.
“There have been a couple of instances when major hospital systems don’t report on some days, while our data is always from the same 25 hospitals,” Hallman said.
A representative at the advisory council said there have been issues with reporting, but it was not able to reveal which hospitals are reporting or failing to data to them, citing a blinding process that conceals the identity of reporting hospitals. As a result, a hospital-by-hospital comparison of data is effectively impossible.
A comparison of ICU numbers from these various sources suggests that the data Jenkins cites more closely mirror those available through other sources, such as estimates published by the U.S. Department of Health and Human Services or the Texas Department of State Health Services.
In contrast to Johnson’s reports, these other sources of data suggest that we are dangerously close to a hospitalization crisis in North Texas.
Conversations with a number of Dallas area ICU nurses suggest ICU nurses face a dire situation. Several have said their hospitals are either at or near capacity, resulting in a cascade of effects that affect the entire hospital system.
“We are constantly full and have to place our patients in other floors where they don’t belong, therefore not getting the best quality care they need,” one nurse said, speaking on the condition of anonymity.
The fact that the mayor’s ICU bed numbers don’t reflect this is perhaps understandable. Hallman said a single measure is not enough to capture the situation, and the mayor’s office is watching the trends closely. Unfortunately, the trends are not looking good, and unless reporting transparency improves, it seems no one knows exactly how close we are to running out of ICU beds.