Adam Interviews medical director about ICU capacity

Adam Interviews

Unity Hospital's Dr. Jason Lyons says capacity numbers can be misleading

ROCHESTER, N.Y. (WROC) — To demonstrate how stressed intensive care units are across the state, medical leaders release capacity numbers which show how much – or how little – room they have left for severely ill patients.

For the last month or so the average ICU capacity in New York has moved between 25% and 30%.

But that number can be misleading.

Dr. Jason Lyons, medical director of Unity Hospital, says capacity levels are based on the maximum number of ICU beds a hospital can create not how many beds they have in their ICU.

He provides an explanation and a description of the current state of his ICU and staff in this interview last week with Adam Chodak:

Adam Chodak: When we look at the number of folks in the ICU, it’s just a number that comes in, you’ve been in the ICU. What does it look like in Unity right now?

Dr. Jason Lyons: Right now in Unity we’re pretty full. In the last few days we’ve had a significant increase in the number of patients in our ICU. We’ve had to expand outside of our ICU to make more ICU beds and those are getting filled up relatively quickly.

AC: And when we hear someone has gone into the ICU what does that look like when it comes to COVID patients?

JL: Unfortunately, we’re seeing more and more people come into the ICU with COVID and it’s variable but most of the time they have increasing oxygen needs and they either try to make it without going on the ventilator or more frequently than not we’re finding they have to go to mechanical ventilation and that can be quite a long stay in the ICU.

AC: When it comes to resources both equipment and people what has that looked like over the last couple of months?

JL: That’s been a strain on every aspect of the hospital. It’s been a strain on every aspect and part of the ICU all from the providers to the nurses to the patient care technicians to the folks cleaning the rooms, everybody is running, you start the day running, you end the day running and everybody is doing more than they have bargained for in the ICU, I can’t stress how much support everybody has needed in order to meet the needs of the stresses and the number of patients in our ICU. The folks here at Unity have been spectacular and the nurses have been wonderful and the techs have been great, but it’s taxing.

AC: When we see 30% ICU capacity, could people take away the wrong impression from that?

JL: Yeah, I think so. When we say that we have 30% capacity in our ICU that’s with us already adding on another 30% of ICU beds and we’re consistently trying to get people better to get out of the ICU so we can take one or two more patients in the ICU. Right now we are not at 30% capacity. I hear those numbers like you do, but that’s a maximum number of ICU beds that we could possibly make in the hospital, that’s not a number that we would ever want to use in the hospital because that would outstrip not only our provider capacities, but nursing capacities and all the other support staff in the ICU.

AC: So in a way you’re at a max level that you’d want to see at this point?

JL: Unity is a smaller hospital than RGH or Strong. Our standard ICU is 20 beds. Right now we have 30 ICU patients right now. We’re expanding out into units that typically aren’t used for intensive care, but have been fitted and staffed for that.

AC: Are all beds created equal?

JL: No. The beds that we’ve created for our surge capacity in the ICU are ICU-level capable. If we were ever to expand out to other units, there would be some sacrifice in terms of the technology we have available, the support staff and some of the ventilator and oxygen therapies and the monitoring, so they’re not all created equal.

AC: What does your staff think, if they think anything at all, when they hear people out in the community say COVID isn’t that dangerous or it only impacts the elderly or those with co-morbidities, what impact does that have on your staff?

JL: That’s the worst part about this pandemic is that there is still a thought out there that this not serious. This is nothing like any of us have ever seen. This is deadly and, yes, we all know many people have had COVID and have recovered from it, but in ICU we see just horrible stories of people who are functional and relatively health who come into the ICU and are struggling to live and we have patients dying of COVID, if not daily, multiple times per week, this is a tragedy that people are not taking this seriously and I can only implore people to maintain distances and wear masks when you are close to people as recommended by the CDC and New York State. This is a different time now than it was over the summer and even earlier this year, this is a terrible pandemic to be going through right now.

AC: And you say people are dying of COVID, what’s the manifestation in the body, what are you actually seeing?

JL: Well, it’s variable, but for the most part in the ICU that means they’ve been having respiratory failure, trouble maintaining their oxygen levels. For some time, we’ve had some patients who have been able to manage with borderline oxygen levels, high levels of oxygen support and frequently what happens is they tucker out and they end up being put on a ventilator and for most the time on the ventilator is quite a long time, we’re talking weeks and they’re able to hold their own, but eventually they either have an infection or they have progressive respiratory failure where we’re unable to manage them on a ventilator. There are other manifestations as well, you know, heart, kidneys, brain, but for the most part someone who passes away of COVID is they dye of the low oxygen levels that we can no longer fix.

AC: All of that sparked by the virus?

JL: Yeah, it is.

AC: What has been the reaction to the vaccine among your staff?

JL: Well, I can tell you that when we first got it, everyone was asking when are they going to get it? And I have to say I’m very pleased that all of our providers have received it unless they’ve already had COVID to begin with and we’ve received the second rounds starting today, our providers got their second shot today and I think there’s some sense of at least some relief in that fact that we are getting the final doses of the vaccine.

AC: Any side effects that you’ve seen so far?

JL: I haven’t heard of many side effects… after round 1 they were pretty minor and round 2 is going in today so we’ll see over the next few days how that’s gone.

AC: As someone who is in the trenches right now what message do you have for the community?

JL: We have a long way to go, we’re getting there, we need to bend the curve and people need to take this virus seriously.

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