736 - Trends in NICU Capacity in Washington State from 2020-2023

Publication Number: 736.6693

Rachel A.. Umoren, University of Washington, Seattle, WA, United States; Vicki Sakata, Northwest Healthcare Response Network, Seattle, WA, United States; Mary A. King, University of Washington School of Medicine, Seattle, WA, United States; Aditya Ravishankar, University of Washington, Seattle, WA, United States; Matthew Cook, University of Washington, Lynnwood, WA, United States; Prashanth Rajivan, University of washington, Seattle, WA, United States; Shan Liu, University of Washington, Seattle, WA, United States; John Feltner, University of Washington School of Medicine, Seattle, WA, United States; Taylor L. Sawyer, University of Washington, Kenmore, WA, United States; Megan Gray, University of Washington School of Medicine, Seattle, WA, United States

Background: To adequately support the needs of its youngest and most vulnerable patients, states must ensure that their healthcare systems are equipped to provide ICU care for critically ill infants and children. The challenges in healthcare were starkly highlighted during the COVID-19 pandemic, which saw a dramatic increase in the number of critically ill patients, challenges in maintaining adequate staffing, and significant financial strain, all of which put unprecedented stress on healthcare facilities.

Objective: This study aims to evaluate the capacity for care of critically ill infants in Washington state in the period during the initial years of the COVID pandemic.

Design/Methods: This retrospective study utilized de-identified data from March 2020-Jan 2023 from the WATrac database, a healthcare resource tracking system run by the Washington State Department of Health (DOH) that includes data on the majority of the level 3 and 4 NICUs in the state as well as a smaller number of Level 2 NICUs; Level 1 facilities were excluded from analysis. The total number of available staffed beds was summed for all units reporting for a given date. Based on the number of units reporting per day, the percentage of units without any staffed available beds was calculated. The rate of beds per unit per day was calculated based on the total number of staffed beds divided by the number units reporting for each date. The number of staffed beds available across the region was sorted by month and a median and IQR of available beds on any given day of that month was calculated.

Results: NICU bed availability data was available for 1057 days of the time period. The database was expanded from 11 to 18 NICUs during the study period. There was a median of 1 available NICU bed in each unit daily (IQR 0, 3). There was a median of 27 NICU beds available in the WATrac network per day (IQR 23, 32, figure 1) and a median of 4 units with zero beds per day (IQR 3, 6,). Over the study period a median of 31% of NICUs have zero beds on a given day (IQR 25, 39%, Figure 2).

Conclusion(s): Nearly a third of all higher level NICUs in WA had no capacity to admit a critically ill newborn on a given day and since many NICUs need to maintain capacity to admit unexpected deliveries or arrivals to their own hospitals, there is extremely limited capacity to accept outside transfers of infants in need. This creates challenges with finding an accepting unit and an increased likelihood of longer transport and separation distance between parents and their infants.

Figure 1. Daily Available Level 2-4 NICU beds in Washington State By Month


Figure 2. Percentage of WATrac NICUs with No Available Beds


Table 1. Demographics
Legend: NICU - Neonatal Intensive Care Unit; * Number unavailable