Hospitals share information about other patients


As of May 7, 2021

Current corona situation in the hospitals
After the previous peak in the number of intensively treated patients at the beginning of January with around 5,800 intensive care places occupied by Covid, we experienced the high point in the third wave at the end of April 2021 with more than 5,000 intensive care beds occupied by Covid. However, the number has been falling continuously and noticeably since the beginning of May. The peak of the first wave in spring 2020 was around 2900 intensive care beds occupied by Covid sufferers.

Currently, hospitals can increasingly switch to standard care again and, for example, catch up on postponed, planned operations.

The hospitals have been reporting their occupancy figures to the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) on a daily basis since spring. DIVI maintains the so-called intensive register and publishes a daily freely accessible report on the current capacities in the hospitals.

In November, the hospitals experienced regional bottlenecks in the intensive care sector. As a result, patients had to be transferred to other hospitals. In order to be able to keep more capacity free, the hospitals have reduced the standard supply as required. This only applies to treatments that can be planned and that are postponed in any way that will not damage your health or even endanger your life. This is intended to create capacities, especially in terms of staff.

So far, the pandemic has shown that hospitals can react quickly to changes. Hospitals have to be prepared for further waves of infection until a vaccine is widely available and the vast majority of the population has been immunized. The clinics will always keep a certain area of ​​the intensive care capacities free. The DKG has presented a concept for the balance between Covid-19 on-call duty and standard care.

Above all, it is very important that people do not avoid the emergency rooms out of fear of Corona. There is no reason to do so. Infection protection in hospitals is guaranteed, and anyone who has a problem should definitely go to a hospital.

Before the Corona crisis, there were around 28,000 intensive care beds nationwide in Germany, 22,000 of which were ventilated. These were on average 70 to 80 percent occupied. Nationwide, capacities were expanded in a joint effort. In addition, all hospitals have created additional ventilation places with the support of central measures by the Federal Ministry of Health. The number of operable intensive care beds with ventilation options suitable for Covid 19 patients has currently been increased to more than 28,000. In addition, there is a reserve that can be activated within a week. This reserve fluctuates between 10,000 and 12,000 beds, depending on the personnel situation. It will only become available when the standard supply is further reduced and further measures are taken.

Why does the total capacity of the intensive care beds fluctuate? 
The number of available intensive care beds depends primarily on the staff capacity. With the reintroduction of lower nursing staff limits and their tightening in summer 2020 or at the turn of the year, the total number of intensive care beds has fallen noticeably. In addition, there is the much greater need for care of Covid sufferers, which ties up additional staff and forces many hospitals to deregister intensive capacities. The fact that the total number does not increase significantly between waves is due, for example, to the fact that hospitals make up for postponed operations, that employees take long postponed vacation or reduce overtime.

Intensive register
The German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI), the Robert Koch Institute (RKI) and the German Hospital Society (DKG) have jointly set up the DIVI Intensive Care Register. A website that can be used to register and inquire about vacant ventilation places in all clinics in Germany. Intensive care physicians at all clinics in Germany can easily query capacities via the online platform. The register insists that all hospitals independently enter their data in a closed area of ​​the database on a daily basis in order to ensure regional coordination of intensive care beds and thus optimal care for Covid 19 patients on this basis. In extreme cases, this means that patients can be supplied with ventilation, regardless of the capacity in the immediate vicinity. You can find the register here.

Capacity information from DIVI and DKG complement each other: The information from the DKG, according to which the formerly 28,000 intensive care beds have meanwhile been expanded to around 40,000 and the former 20,000 ventilation places have been increased to 30,000, includes a large number of responses that go beyond the reports in the DIVI register. The register is primarily geared towards hospitals that already had established intensive care units, which were defined in the hospital plans of the federal states, before the corona crisis. The register therefore does not record the newly built "reserve capacities". These are, for example, recovery rooms that have been converted into Covid-19 stations and that have also been equipped with ventilators. Here, too, Covid 19 patients receive intensive medical care and ventilation.

For the first phase of the pandemic until the end of September 2020, the legislature has implemented a financial rescue package as an instrument for the economic stability of hospitals. This should be continuously checked by an advisory board made up of health insurers and hospital representatives.

On November 18, 2020, the Bundestag and Bundesrat provided a "rescue package 2.0" with the Civil Protection Act. This now again provides for staggered free lump sums, which give the hospitals a certain economic security if they do not postpone operations that are urgently needed in order to keep capacities free for COVID-19 patients. A year-round compensation is also planned, which reimburses hospitals for lower revenues - on the basis of the previous year's income. The DKG partially welcomes these regulations, but has also expressed some criticisms of the design.

From the DKG's point of view, it is important that the financing of the hospitals is adjusted in the medium term to the balanced balance between readiness and care. The previous financing system must be reviewed. Nursing is no longer subject to the usual flat-rate flat rates for good reason. The question now arises as to whether one should not generally return to an annual budget regardless of the number of patients and treatments - at least in the case of primary care hospitals. There are many areas in the clinics with high storage costs that cannot be financed on a long-term basis via the DRG system.

For the DKG it is clear that hospitals will also need reserves in the future and must be prepared for the highest levels of stress.

DKG press releases can be found here.