TY - JOUR T1 - Hospital bed capacity and usage across secondary healthcare providers in England during the first wave of the COVID-19 pandemic: a descriptive analysis JF - BMJ Open JO - BMJ Open DO - 10.1136/bmjopen-2020-042945 VL - 11 IS - 1 SP - e042945 AU - Bilal Akhter Mateen AU - Harrison Wilde AU - John M Dennis AU - Andrew Duncan AU - Nick Thomas AU - Andrew McGovern AU - Spiros Denaxas AU - Matt Keeling AU - Sebastian Vollmer Y1 - 2021/01/01 UR - http://bmjopen.bmj.com/content/11/1/e042945.abstract N2 - Objective In this study, we describe the pattern of bed occupancy across England during the peak of the first wave of the COVID-19 pandemic.Design Descriptive survey.Setting All non-specialist secondary care providers in England from 27 March27to 5 June 2020.Participants Acute (non-specialist) trusts with a type 1 (ie, 24 hours/day, consultant-led) accident and emergency department (n=125), Nightingale (field) hospitals (n=7) and independent sector secondary care providers (n=195).Main outcome measures Two thresholds for ‘safe occupancy’ were used: 85% as per the Royal College of Emergency Medicine and 92% as per NHS Improvement.Results At peak availability, there were 2711 additional beds compatible with mechanical ventilation across England, reflecting a 53% increase in capacity, and occupancy never exceeded 62%. A consequence of the repurposing of beds meant that at the trough there were 8.7% (8508) fewer general and acute beds across England, but occupancy never exceeded 72%. The closest to full occupancy of general and acute bed (surge) capacity that any trust in England reached was 99.8% . For beds compatible with mechanical ventilation there were 326 trust-days (3.7%) spent above 85% of surge capacity and 154 trust-days (1.8%) spent above 92%. 23 trusts spent a cumulative 81 days at 100% saturation of their surge ventilator bed capacity (median number of days per trust=1, range: 1–17). However, only three sustainability and transformation partnerships (aggregates of geographically co-located trusts) reached 100% saturation of their mechanical ventilation beds.Conclusions Throughout the first wave of the pandemic, an adequate supply of all bed types existed at a national level. However, due to an unequal distribution of bed utilisation, many trusts spent a significant period operating above ‘safe-occupancy’ thresholds despite substantial capacity in geographically co-located trusts, a key operational issue to address in preparing for future waves. ER -