APPENDIX - tmc.edu€¦ · 2 days ago · APPENDIX AS OF OCTOBER 11, 2020. 2 This document is...

This document is solely intended to share insights and best practices rather than specific recommendations. Individual institution data is shown as reported and has not been independently verified

1

APPENDIXAS OF OCTOBER 11, 2020

2This document is solely intended to share insights and best practices rather than specific recommendations. Individual institution data is shown as reported and has not been independently verified

Data from Texas Department of State Health Services

14

10

24

14,000

2,000

26,000

16

4,000

16,000

28,000

10,000

20,000

0

30,000

22,000

6

20

12

6,000

4

18

8

22

8,000

12,000

2

28

0

32,000

18,000

26

24,000

08/1

808

/17

08/1

608

/14

08/1

208

/10

08/0

908

/08

08/0

6

08/0

3

07/2

8

07/2

5

09/0

6

15%

08/1

9

07/1

2

08/2

0

06/1

7

06/3

0

07/2

4

07/2

107

/20

06/2

6

07/1

9

5%

07/1

3

07/1

8

08/0

2

25%

10/0

7

08/2

7

07/1

707

/15

10/0

6

07/1

1

07/0

2

11%

08/2

208

/21

08/2

8

07/0

5

07/0

1

08/2

3

5/10

-5/1

6

06/2

9

09/1

7

06/2

8

08/1

5

07/1

6

08/2

9

06/2

7

10/0

2

09/0

2

22%

07/2

6

08/0

5

06/2

5

10/1

0

06/2

306

/22

10/0

5

06/2

1

08/2

4

06/1

8

07/1

0

6%

06/1

506

/14

09/2

2

08/2

5

06/1

2

5/31

-6/6

07/1

4

15%

5/3-

5/9

4%

08/0

4

09/0

9

10/0

8

9%

06/0

906

/11

06/0

8

07/0

3

5/24

-5/3

0

3%

23%

06/1

6

09/1

6

07/3

1

08/2

6

7%

3%

07/2

7

08/3

1

10/0

3

09/0

109

/03

09/0

4

06/2

4

09/3

0

09/0

509

/07

6%

07/0

7

08/0

1

09/0

8

09/1

409

/12

07/0

8

7%

06/1

9

09/2

4

09/1

5

08/3

0

09/1

809

/20

09/1

1

06/2

0

08/1

3

06/1

3

4/26

-5/2

09/1

909

/21

5/17

-5/2

3

07/2

3

09/2

3

06/1

0

09/1

0

09/2

509

/26

07/0

9

07/0

4

09/2

709

/29

09/1

3

06/0

7

09/2

8

08/1

1

07/3

0

10/0

1

07/0

6

10/0

4

07/2

9

07/2

2

10/0

9

08/0

7

Source: TX Health and Human Services (https://dshs.texas.gov/coronavirus/AdditionalData.aspx)

1. Austin, Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery and Waller2. Test data on chart will have a 1-day lag

COVID-19 CASE GROWTH TRENDOctober 10, 2020

“TMC” refers to the group of systems that make up Texas Medical Center

7-day trend of daily # of tests performed7-dy trend of % test positivity for COVID-19

Monitoring threshold:

Threshold is exceeded by the occurrence of a positive 7-day average growth in % test positivity

Note: Public testing data for this chart may lag several weeks

1

Note: Excludes days with no tests reported

Reflects retroactive changes in testing data made by Texas Department of Health and Human Services on 6/9/2020

COVID-19 TESTING TRENDS FOR GREATER HOUSTON AREA1

(weekly averages)

Note: DSHS released 13,622 older cases on 9/22/2020 impacting positivity trend


3

AVERAGE DAILY COVID-19 TESTING METRICS BY WEEK ACROSS GREATER HOUSTON AREA

5,075 8,265 8,654 8,271 5,930

11,217

5,259

9,352 9,99212,045

10,642 10,967 11,343

30,057

16,020

12,703 15,203

610,000

20,000

16

15,000

24

2

25,000

5,000

35,000

30,00022

4

0

10

8

12

14

20

18

0

7.6%

Week 5(4/20-4/26)

4.3%

Week 16(7/6-7/12)

10.3%

Week 7(5/4-5/10)

Week 8(5/11-5/17)

Week 13(6/15-6/21)

3,373

Week 9(5/18-5/24)

Week 21(8/10-8/16)

4.5%

16,616

18.0%

3.5%

Week 10(5/25-5/31)

Week 12(6/8-6/14)

3.6%

Week 25(9/7-9/13)

Week 24(8/31-9/6)

6.9%

16.0%

Week 14(6/22-6/28)

8.8%

2.8%

Week 15(6/29-7/5)

Week 6(4/27-5/3)

Week 17(7/13-7/19)

13.4%

Week 19(7/27-8/2)

16.6%

13,092

Week 18(7/20-7/26)

Week 27

(9/21-9/27)

6.9%

Week 22(8/17-8/23)

Week 11(6/1-6/7)

6.6%

10.6%

7.5%

2.8%

Week 23(8/24-8/30)

7.5%13,246

Week 26(9/14-9/20)

19,265

14,223

11.3%19,163

17.6%

22.2%

Week 28

(9/28-10/4)

10.8%

6.7%

Week 20(8/3-8/9)

Source: TX Health and Human Services (https://dshs.texas.gov/coronavirus/AdditionalData.aspx)

1. Austin, Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery and Waller

COVID-19 CASE GROWTH TREND


7-day trend of % test positivity for COVID-19

1 October 10, 2020

Note: Excludes days with no tests reported

Reflects retroactive changes in testing data made by Texas Department of Health and Human Services on 6/9/2020

Data from Texas Department of State Health Services Note: Public testing data for this chart may lag several weeks

7-day trend of daily # of tests performed


TOTAL TMC COVID-19 POSITIVE PATIENTS (ICU & MED SURG) IN HOSPITAL

451

492

484

438

419

403

399

426

527

579

609

641

626

634

635

680

682

776

832

883

921

946

997

1,08

81,

137

1,21

11,

299

1,36

41,

428

1,44

71,

545

1,69

01,

747

1,86

31,

884

1,93

32,

226

2,26

12,

204

2,31

52,

365

2,33

12,

344

2,46

22,

455

2,44

42,

402

2,39

92,

382 2,

312

2,32

72,

367

2,33

32,

319

2,29

32,

164

2,07

82,

060

2,04

41,

964 1,

853

1,80

11,

664

1,63

41,

595

1,56

11,

491

1,45

21,

391

1,35

31,

306

1,23

91,

248

1,21

01,

190

1,14

31,

127

1,15

91,

119

1,03

999

395

993

890

891

687

781

576

675

672

873

873

670

669

768

566

165

063

059

159

360

359

154

954

954

454

454

353

653

050

648

348

148

047

847

848

547

046

144

346

146

044

743

742

042

743

845

346

445

846

945

947

446

8

900800

1,700

300

1000

1,900

1,200

200

700

2,200

500

2,100

400

1,800

1,400

2,500

1,600

2,000

1,500

2,4002,300

1,300

1,1001,000

600

2,02

9

09/1

1

07/0

1

10/1

1

09/0

3

08/1

4

07/2

4

07/0

4

06/0

75/

31-6

/06

07/0

6

4/12

-4/1

8

06/0

8

06/2

9

07/2

2

08/0

8

07/0

8

06/2

7

5/17

-5/2

3

07/0

9

08/2

7

07/2

7

06/3

0

07/1

1

08/3

1

07/1

3

09/0

2

07/1

8

07/2

8

08/1

6

06/2

3

07/1

507

/16

09/2

9

07/1

0

10/0

2

08/2

5

09/2

7

07/1

7

06/2

5

07/2

0

06/1

8

09/0

7

07/2

1

06/1

5

07/1

9

1,92

7

07/2

3

06/1

3

07/2

5

06/1

2

07/2

6

06/1

6

08/0

5

5/24

-5/3

0

06/2

1

5/03

-5/0

9

07/0

5

06/0

9

06/1

9

06/1

0

07/2

9

07/3

108

/01

07/0

7

08/0

3

07/0

3

08/2

4

06/2

0

09/0

8

06/1

7

06/1

4

08/0

4

08/2

9

09/1

0

08/0

7

08/2

1

08/1

008

/11

5/10

-5/1

6

09/1

3

08/1

2

08/2

3

08/3

0

08/2

2

08/1

7

09/0

5

08/1

9

06/2

2

08/0

2

08/2

0

07/0

2

08/2

6

07/3

0

4/19

-4/2

5

08/2

8

09/0

6

09/0

1

09/0

4

08/1

5

09/0

9

07/1

4

06/2

6

10/0

6

09/1

2

09/1

4

08/1

3

09/1

5

08/0

6

09/1

6

4/26

-5/0

2

09/1

709

/18

09/1

909

/20

08/0

9

09/2

109

/22

09/2

5

07/1

2

09/2

6

06/1

1

09/2

3

4/05

-4/1

1

08/1

8

09/2

8

09/3

010

/01

06/2

4

10/0

310

/04

10/0

5

10/0

710

/08

10/0

910

/10

06/2

8

1,64

4

09/2

4

7-day trend of COVID-19 patients in ICU & Med Surg

Daily COVID-19 patients in ICU & Med Surg

Daily

CO

VID-

19 p

ositi

ve p

atie

nts i

n IC

U a

nd M

ed S

urg

Source: Internal data collected from the systems CHI Texas Division, Harris Health System, Houston Methodist, MD Anderson Cancer Center, Memorial Hermann, Texas Children’s Hospital, UTMB“TMC” refers to the group of systems that make up Texas Medical CenterAll guidelines should be in accordance with CDC guidelines

2

Current status: 1.2% daily growth rate (averaged over 7 days) in COVID-19 patients in med surg and ICU combined

Notes:While new daily cases may fluctuate for a variety of reasons (e.g., testing), the number of COVID-19 positive patients being treated in med surg and ICU shows an objective view of how COVID-19 impacts hospital systems

October 11, 2020BED OCCUPANCY

June July AugApril – May (weekly averages) Sep


TOTAL TMC COVID-19 POSITIVE PATIENTS IN ICU BEDS

Daily

CO

VID-

19 p

ositi

ve p

atie

nts i

n IC

U


2

Current status: 0.3% daily growth rate (averaged over 7 days) in COVID-19 patients in ICU

Notes:While new daily cases may fluctuate for a variety of reasons (e.g., testing), the number of COVID-19 positive patients being treated in ICU shows an objective view of how COVID-19 impacts hospital systems

October 11, 2020ICU BED OCCUPANCY

192

225

204

178

175

157

170

193

224

224

223

230

221

207

216

217

227

237

252

273

303

304

329

347

352

362

374

398

414

414

445

460

480

507

512

540

568

589

600

615

626

646

651

646

682

674

676

678

689

700

667

664

686

691 71

671

468

169

168

267

765

062

563

963

261

756

857

054

251

251

050

149

647

746

046

445

043

240

441

741

639

836

136

335

933

532

631

230

230

128

528

927

627

126

627

126

526

224

622

422

022

521

922

720

720

318

918

219

118

818

617

116

115

815

415

815

416

317

416

415

516

416

216

215

915

716

315

115

314

914

214

915

115

315

915

0

100

400

50

250

650

300

700

500

450

200

350

550

750

0

150

600

07/2

7

09/2

4

08/1

8

07/1

1

07/2

4

09/0

2

09/2

3

07/1

2

09/1

4

08/1

3

08/1

0

09/2

9

08/0

8

07/1

5

07/0

407

/03

10/0

9

07/1

7

06/1

9

07/0

2

09/2

7

08/0

3

06/2

9

4/26

-5/0

2

07/0

7

07/2

1

09/1

009

/09

5/31

-6/0

6

4/12

-4/1

8

06/2

7

07/2

3

08/2

7

06/2

606

/28

07/2

5

06/2

5

07/0

6

07/2

6

09/2

0

06/2

306

/21

07/0

1

07/2

2

08/1

9

07/2

8

10/0

1

08/1

6

08/1

2

07/2

9

06/1

8

07/3

0

09/2

5

06/1

7

09/3

0

07/0

9

10/0

2

06/1

6

08/2

6

08/0

9

10/0

3

07/3

1

06/0

7

06/1

4

09/2

6

08/1

4

08/0

1

08/2

0

5/24

-5/3

0

07/1

4

09/0

5

569

5/17

-5/2

3

10/0

4

07/0

8

09/0

3

07/1

3

10/0

5

06/0

9

08/0

6

06/1

2

08/0

7

09/1

9

08/1

1

09/0

8

06/2

4

08/1

508

/17

06/2

0

08/2

2

06/1

0

08/0

4

08/2

3

4/19

-4/2

5

5/10

-5/1

6

07/2

0

10/1

1

08/2

8

08/2

5

08/2

9

09/0

6

06/3

0

08/2

1

08/3

0

06/1

5

08/3

1

07/1

0

5/03

-5/0

9

08/0

2

09/0

1

07/1

8

08/0

5

09/0

4

10/0

6

07/1

6

06/0

8

10/0

7

4/05

-4/1

1

09/0

7

06/1

3

09/1

5

10/0

8

06/2

2

09/1

109

/13

07/0

5

06/1

1

10/1

0

09/2

8

09/1

2

09/1

609

/17

08/2

4

09/1

8

09/2

1

07/1

9

09/2

2

7-day trend of COVID-19 patients in ICU

June July AugApril – May (weekly averages)

Sep


TOTAL TMC COVID-19 POSITIVE PATIENTS IN MED SURG BEDS26

728

026

124

424

523

023

430

335

538

641

140

542

741

946

345

553

958

061

061

864

266

874

178

584

992

596

61,

014

1,03

31,

230

1,26

71,

356

1,37

21,

393

1,63

71,

661

1,58

91,

689

1,71

91,

680

1,69

81,

780

1,78

11,

768

1,72

41,

710 1,

682

1,64

51,

663

1,68

11,

642

1,60

31,

509

1,48

31,

387

1,37

81,

314

1,30

21,

214

1,16

91,

047

1,07

5 1,02

51,

019

979

942

890

857

829

779

784

760

758

739

710

743

721

678

630

600

603

582

604

575

514

481

467

452

467

470

435

432

423

415

426

410

366

374

376

384

346

360

362

353

355

350

359

345

325

327

322

324

315

311

306

306

279

299

298

288

280

257

276

285

304

322

309

318

306

315

318

0

1,200

800

1,300

1,100

1,600

1,800

200

100

300

400

1,400

500

900

600

1,000

1,500

700

1,700

06/2

9

08/3

1

08/2

7

07/1

1

1,10

0

07/1

0

08/1

8

09/0

1

07/1

5

07/0

807

/07

07/1

4

07/0

4

08/0

4

4/05

-4/1

1

07/0

51,

461

07/1

6

08/2

808

/26

07/0

2

06/2

0

08/1

2

07/0

1

08/2

2

5/31

-6/0

6

07/1

8

4/26

-5/0

2

08/1

6

07/1

9

08/2

1

09/1

3

07/2

007

/22

06/1

2

09/0

3

07/2

307

/25

07/2

6

06/2

7

10/0

9

06/2

8

06/2

2

07/2

9

06/2

406

/23

07/3

0

09/1

8

06/1

906

/17

07/3

108

/01

06/1

6

07/2

4

06/1

1

1,36

7

06/1

5

08/0

2

10/1

0

08/1

9

07/0

3

06/1

3

08/0

5

08/0

8

09/1

5

09/0

5

08/0

9

06/1

4

08/1

308

/14

09/2

2

06/2

1

08/1

7

08/0

6

07/2

7

10/0

3

07/2

1

08/2

0

08/2

9

07/1

3

08/2

4

10/1

1

08/3

0

09/0

4

08/0

3

09/0

6

5/24

-5/3

0

06/0

8

09/0

7

06/0

7

08/1

1

09/0

2

09/0

8

08/2

5

09/0

9

07/0

6

09/1

0

10/0

1

06/3

0

4/12

-4/1

8

5/17

-5/2

3

09/1

109

/12

07/0

9

06/2

6

09/1

4

07/2

8

09/1

6

08/1

5

5/03

-5/0

94/

19-4

/25

09/1

709

/19

09/2

009

/21

08/1

0

06/1

8

09/2

3

09/3

0

08/2

3

07/1

2

06/0

9

09/2

4

06/2

5

09/2

509

/26

09/2

709

/28

09/2

9

10/0

210

/04

08/0

7

10/0

510

/06

5/10

-5/1

6

10/0

7

06/1

0

10/0

8

1,06

6

07/1

7

7-day trend of COVID-19 patients in Med Surg

Daily COVID-19 patients in Med Surg

Daily

CO

VID-

19 p

ositi

ve p

atie

nts i

n M

ed S

urg


2

Current status: 1.8% daily growth rate (averaged over 7 days) in COVID-19 patients in med surg

Notes:While new daily cases may fluctuate for a variety of reasons (e.g., testing), the number of COVID-19 positive patients being treated in Med surg shows an objective view of how COVID-19 impacts hospital systems

October 11, 2020BED OCCUPANCY

June July AugApril – May(weekly averages)

Sep


7

TMC CAPACITY PLANNING PROTOCOL

Definitions Capacity planning

Phase 1 Intensive Care Beds

§ ICU bed configuration and staffing under non-pandemic situations

§ Builds on ICU capacity using our existing plans - through increasing staffing levels and ratios, mobilizing additional Intensive Care equipment & utilizing additional beds


§ Further planned utilization of Phase 2 levers of surge capacity to provide additional temporary Intensive Care capacity


Our hospitals are very experienced at operating at near 100% capacity and are able to flex up and down when needed (e.g., with additional staffing)

We have proactively developed our surge plans and are able to add extensive capacity when needed (e.g., by adding additional staff, additional equipment, additional beds, and increasing densification)

Additionally, we can moderate intake of non-COVID 19 patients, based on the clinical needs of the elective portion of these patients. Non-COVID 19 patients today represents the vast majority of our patients.


8

978 6,014 318 3,162150

OVERVIEW OF TMC BED STATUS

COVID-19 – Intensive Care Beds usage

Non-COVID-19 –Intensive Care Beds usage

COVID-19 - Medical Surgical Beds usage

Current available (unused) beds2

Additional capacity (if needed)

Non-COVID-19 – Medical Surgical Beds usage

Phase 1 Intensive Care Beds (1330 beds) Phase 2 Intensive Care Beds (1703 beds) Phase 3 Intensive Care Beds (2207 beds)� ICU bed configuration under non-pandemic

conditions� Planned additional Intensive Care capacity for the

duration of pandemic� Planned temporary Intensive Care surge capacity� Ability to further increase Phase 3 through conversion of

non-Intensive Care beds

Phase 1 IC1

Phase 2 Intensive Care

Phase 3 Intensive Care

TMC leaders are actively managing, and can adjust, elective procedures to ensure sufficient capacity for

COVID-19 needs

2 October 11, 2020

Intensive care beds in use

Medical/Surgical beds in use

Empty beds

1. Intensive Care2. Total bed availability may fluctuate over time, given ongoing planning and operational considerations. On June 28th and 29th, the total unoccupied beds should have been 3,506 and

3,565, respectively. These data updates did not change ICU or med-surg occupancy and did not change ICU capacity percentages reported on any date.

Current phase


30

25

20

15

10

5

0

April May June

% c

ombi

ned

occu

panc

y fr

om C

OVI

D-19

2 October 11, 2020

1. Daily occupancy is smoothed over a two-day periodNote: For projections, non-COVID-19 occupancy is assumed to stay constant at modeling rate on day of forecast

TMC 2-WEEK PROJECTION USING BED OCCUPANCY GROWTH% total bed occupancy1

Internal data collected from CHI St Luke’s, Harris Health System, Houston Methodist, MD Anderson Cancer Center, Memorial Hermann, Texas Children’s Hospital, UTMB“TMC” refers to the group of individual hospitals and institutions that make up Texas Medical CenterAll guidelines should be in accordance with CDC guidelines

• For the past 7 days, the average daily growth in occupancy for COVID-19 patients has been:⁻ 0.3% for ICU ⁻ 1.8% for Med Surg

• TMC is in Phase 1 Intensive Care Capacity

• If this growth continues, TMC: ⁻ Will likely not move into

Phase 3 Intensive Care within 2 weeks

• This calculation assumes a similar occupancy for non-COVID-19 procedures as today

BED OCCUPANCY

The health and wellbeing of our community requires that each of us do our part to slow the spread of COVID-19, including:• Maintaining social distance• Wearing a mask while in public• Washing hands regularly• Test and self-isolate, if sickJuly

Phase 1 IC

Phase 2 IC

August

Phase 1 IC

Phase 2 IC

Phase 1 IC

Today

Sept

Phase 2 IC

Phase 1 IC

Oct 25

Med/Surg actualsICU forecastMed/Surg forecast

ICU actuals


TMC EXPECTED PPE NEEDS

1. Calculated using trailing 2-week average burn rateSource: Internal data collected from the systems CHI Texas Division, Harris Health System, Houston Methodist, MD Anderson Cancer Center, Memorial Hermann, Texas Children’s Hospital, UTMB

3

N95 respirator masks

Surgical face masks

Eye protection

Gowns

Gloves

Estimated days available

274

144

634

121

45

Average daily burn rate1

7,572

133,336

4,259

55,792

1,037,641

Status

TMC SYSTEM EQUIPMENT & PPE NEEDS

No concernModerate concernWarning

October 11, 2020


Monitoring threshold:30-day supply of critical PPE items

Current status:All critical PPE items within range

Note:Data shown represents all TMC institutions and might vary from institution to institution


15,32917,479 17,564

Expected capacity (4-6 weeks)

10,000

Expected capacity (2-4 weeks)

5,000

Current capacity

Turnaround time currently 1-48 hours depending on site

PCR tests, (#/day)

Monitoring threshold: 5,000-10,000 PCR tests per day available for hospital patients and healthcare worker surveillance (with <24 hour turnaround time)

Notes:Capacity is dependent on critical supplies (reagents)

October 11, 2020


Source: Internal data collected from the systems Baylor College of Medicine, CHI Texas Division, Harris Health System, Houston Methodist, MD Anderson Cancer Center, Memorial Hermann, Texas Children’s Hospital, UT Health, UTMB

4COVID-19 TESTING CAPACITY

1. Austin, Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery and Waller

TMC TESTING CAPACITYTMC TESTING CAPACITY


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TMC DATA COLLECTION PROCESSClinical dataPrevious day’s clinical data submitted by each hospital system1 by 4p.m. daily Bed capacity data regularly confirmed with each hospital system as individual surge capacity plans evolve

Houston MSA COVID-19 casesNew daily COVID-19 case data for Houston MSA2 collected from TX DHS3 (Data captured on publication date, but reflects data from the previous day)

Dashboard compilationHospital clinical data and Houston MSA data analyzed and aggregated into dashboards by TMC

1. System-wide clinical data collected from CHI Texas Division, Harris Health System, Houston Methodist, MD Anderson Cancer Center, Memorial Hermann, Texas Children’s Hospital, UTMB. TMC institutions represent ~70-80% of licensed beds in the 9 Houston MSA counties

2. Houston MSA includes 9 counties: Austin, Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery and Waller3. Source: txdhs.gov

Houston MSA COVID-19 testsNew daily testing data for Houston MSA2 collected from TX DHS3 (Data captured on publication date, but reflects data from 2 days prior)

TMC dashboard publicationFinalized dashboard published on tmc.edu website

Leadership ReviewCompiled dashboards reviewed and finalized by TMC leadership

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