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3 ways hospital demand could change after the Covid-19 surge

April 23, 2020

    The history books will certainly remember how quickly and nimbly hospitals and health systems ramped up to meet the Covid-19 challenge head on. Not only have most health systems successfully expanded bed, ICU, and ventilator capacity to prepare for worst-case Covid-19 projections, but thousands of clinicians have answered the call to return to the frontlines to care for patients during surges.

    Covid-19 weekly webinar: What you need to know in 30 minutes

    But health care isn't simply a function of staff and beds. It's also about demand for care, driven by demographics and the complexity of our patients' needs—and understanding the nature of the demand ahead of us is the next challenge for health care leaders in our new world.

    In our recent presentation on global intelligence on Covid-19, we describe three kinds of demands that health systems will face in the near future—each with their own timing, complexity, and throughput implications.

    1. Continued demand from patients with Covid-19

    Community transmission still remains a challenge, and with increasing pressure to relax restrictions, we can expect most hospitals to continue to see Covid-19 patients in the near-term. Whether that demand remains in steady decline or experiences intermittent spikes will largely depend on whether we can scale up testing, monitoring, and contact tracing.

    As we've already seen, Covid-19 patients who end up in the hospital tend to be sicker, stay longer, and be frailer when ready for discharge when compared with usual hospital patients. For hospitals—as the last line of defense—this means critical care capacity, safety protocols, and effective discharge plans will continue to be critical competencies.

    2. Postponed demand for elective surgeries

    For markets like the United States, Australia, parts of Latin America, and continental Europe, where elective surgery makes up a sizeable share of hospital revenues, the moratorium on planned procedures has been financially crippling. Various markets are now starting to assess whether they're ready to resume.

    But the overarching question we need to answer before making a decision is: 'Are we on a downslope when it comes to Covid-19 cases?' A recent blog by my colleagues Shay Pratt and Rachel Matthews digs into how to determine that—and even if we are on the downslope, clinicians and planners will have to make a number of difficult decisions to figure out how to resume elective surgeries as quickly and safely as possible.

    3. Suppressed demand for medical care

    Another unanswered question that all health systems are going to have to understand and prepare for surrounds suppressed demand for medical care. Most hospitals have seen dramatic declines in their ED presentations and bed occupancy. To put that in perspective, the National Health Service of England usually runs a bed occupancy rate of about 90%; recent reporting finds that the national average is somewhere around 40% occupancy and ED presentations declined by 24% in April.

    While social distancing measures have reduced some non-elective issues such as car accidents, the pandemic hasn't cured most of the emergency issues that people face on a regular basis. So where are these patients? Are they suffering at home? And when they do come to the hospital, what will it take to treat them?

    Health systems need to follow the lead of their peers who are looking to the population health capabilities they've already built to proactively find and support these patients who are missing care.

    Another challenge? Timing.

    Now, my description implies that these three kinds of demands won't happen at the same time. But I think it's likely they will. That puts hospital operators in the challenging position of managing a new infectious disease, a backlog of elective volumes, and complications from delayed and missed care—simultaneously.

    If I can finish where I started, which is with good news, the entire industry is focused on these challenges—which means solutions are going to emerge quickly. Every week, we're sharing updates on what we've learned over the past seven days on the global approach to our new normal.

    Please join us next week, or check out past presentations.

    Covid-19 weekly webinar: What you need to know in 30 minutes

    Every week Advisory Board's Vidal Seegobin will lay out in 30 minutes the most important Covid-19 developments for global health care executives, based on what's happening around the world. If you make time for only one call each week to stay up to date on the pandemic, this is the one. We're hosting two sessions per week to accommodate members around the world.

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