Predicting COVID19 Critical Care Beds - The London North-West University Healthcare Trust Experience

ABSTRACT

Our trust has an urgent need to make short-term (3-4 days in advance) informed operational decisions which take into account best-practice treatment regimens and known clinical features of COVID19 inpatients. We believe that any model which is relied upon for operational decision making should have clinically identifiable parameters. Our models parameters take into account the conversion rates from acute wards into wards equipped with Non-Invasive Ventilation (NIV) and Mechanical Ventilation (MV), the typical time that these conversions take place and, the historical non-COVID usage of NIV and MV beds. We have observed that this clinical performance is mathematically identical to a series of linear delays on the time varying inpatient level. High frequency inpatient data, sampled [~]4 hourly, has allowed our hospital trust to predict total critical care usage up to 4 days in advance without making any assumptions on upcoming inpatients. It is based entirely upon current bed occupancy levels and measured clinical pathways. Through back-testing over the recent 4 months, the bounds of this model include 93.8% of all 4 day inpatient sequences. The average next-day error is 0.8 (95% CI 0.44, 1.15) and so the system tends to over-predict the next day critical care inpatients by approximately 1 bed. Potential extensions to the basic model include adjustments for seasonality, case mix, probabilistic marginalisation and known discharges.