By September 15, 2021, 15.5% of US counties were anticipated to experience hospital workforce staffing strains because of COVID-19 hospitalizations, with an estimated 320 counties needing to implement crisis workforce strategies and another 167 requiring contingency workforce strategies, according to an analysis by researchers who developed the County Hospital Workforce Estimator (CHWE), a new online tool designed to predict ICU workforce shortages based on COVID-19 caseloads.

For the 320 counties facing dangerous shortfalls in ICU staff, the CHWE projects that each intensivist could become responsible for at least 24 severely ill patients at one time, a number that is at least twice the normal average. Subsequently, the analysis notes that these counties will have to be quick in implementing crisis workforce strategies, most notably bringing in and training non-ICU practitioners to provide critical care services, a practice sometimes referred to as battlefield promotions.

For the 167 counties at risk for shortfalls, COVID-19 hospital occupancy is predicted to reach 25% or higher. For these counties, the analysis recommends implementing a variety of contingency workforce strategies, including increasing patient counts per team, using float pools, and granting overtime pay. It also notes that counties in this group that are already facing workforce constraints may need to adopt crisis staffing strategies instead.

The goal of the CHWE is to help public health officials determine the need for additional public health measures, such as social distancing and mask mandates, and to help hospital administrators be proactive in planning for increased patient loads and preventing workforce shortfalls. These measures may prove crucial, particularly as increasing data suggest that healthcare workers are facing such high levels of stress and trauma during the pandemic that many are contemplating leaving the profession altogether. In a recent Washington Post-Kaiser Family Foundation poll, roughly 30% of healthcare workers reported contemplating leaving their profession, whereas in the Medscape National Physician Burnout & Suicide Report 2021, 42% of physicians surveyed reported burnout, with ICU physicians reporting the highest levels at 51%.

The CHWE is the first tool to examine hospital workforce strain at the county level. It was developed by researchers at the Fitzhugh Mullan Institute for Health Workforce Equity at the George Washington University in collaboration with the National Association of County & City Health Officials, the healthcare improvement company Premier Inc, and the healthcare data and analytics organization IQVIA.