Assessment of Critical Care Surge Capacity During the COVID-19 Pandemic in Japan

Abstract

Japan has the highest proportion of older adults worldwide but has fewer critical care beds than most high-income countries. Although the COVID-19 infection rate in Japan is low compared with Europe and the United States, by the end of 2020, several infected people died in ambulances because they could not find hospitals to accept them. Our study aimed to examine the Japanese healthcare system's capacity to accommodate critically ill COVID-19 patients during the pandemic. We created a model to estimate bed and staff capacity at 3 levels of pandemic response (conventional, contingency, and crisis), as defined by the US National Academy of Medicine, and the function of Japan's healthcare system at each level. We then compared our estimates of the number of COVID-19 patients requiring intensive care at peak times with the national health system capacity using expert panel data. Our findings suggest that Japan's healthcare system currently can accommodate only a limited number of critically ill COVID-19 patients. It could accommodate the surge of pandemic demands by converting nonintensive care unit beds to critical care beds and using nonintensive care unit staff for critical care. However, bed and staff capacity should not be expanded uniformly, so that the limited number of physicians and nurses are allocated efficiently and so staffing does not become the bottleneck of the expansion.Training and deploying physicians and nurses to provide immediate intensive care is essential. The key is to introduce and implement the concept and mechanism of tiered staffing in the Japanese healthcare system. More importantly, most intensive care facilities in Japanese hospitals are small-scaled and thinly distributed in each region. The government needs to introduce an efficient system for smooth dispatching of medical personnel among hospitals regardless of their founding institutions.

Control Centre for Intensive Care as a Tool for Effective Coordination, Real-Time Monitoring, and Strategic Planning During the COVID-19 Pandemic

“…Central reporting systems for the monitoring of ICU capacities were therefore established in some countries [ 17 ]. The absence of such a platform, often combined with a fragmented health care system and small ICU facilities, may slow down the response and hold back the provision of appropriate care to critically ill patients, both with and without COVID-19 [ 18 ].…”

Disparities in adult critical care resources across Pakistan: findings from a national survey and assessment using a novel scoring system

“…This could potentially leave critical care nurses more susceptible to burnout. Healthcare systems abroad employ tiered staffing models to circumvent shortages of healthcare workers by repurposing staff from other specialties for specific critical care procedures, and this is recommended in managing ICU surge capacity [ 24 , 25 ]. More work should be done in introducing policies and strategizing around the current constraints in critical care human resources.…”

Japan's Slow Response to Improve Access to Inpatient Care for COVID-19 Patients

“…Most hospitals (79%) and clinics (96%) are owned by entities in the private sector ( Table 2 ). Despite public subsidies, the practice of hospitalizing COVID-19 patients resulted in large revenue losses for many hospitals, which is a strong disincentive among independently financed private hospitals with small budgets ( 18 ). In addition, most national hospitals belong to independent external agencies; the majority of public hospitals are either small- to medium-sized or owned by independent agencies or public service organizations such as the Japan Red Cross Society and Japan Agricultural Cooperatives.…”

“…Here, curative beds are those which remain after excluding beds for other purposes (infectious diseases, tuberculosis, psychiatry, and long-term care), meaning beds for general usage ( 11 ); some are not used for acute care, but are actually taken for rehabilitation or sub-acute care. The number of curative beds designated for acute phase patients should be smaller; a recent study estimated that there were actually 3.3 per 1,000 persons, which may be more accurate ( 18 ). The official statistics are likely inaccurate due to the insufficient classification of beds.…”