• Bilal Akhter Mateen, Harrison Wilde, John M Dennis, Andrew Duncan, Nick Thomas, Andrew McGovern, Spiros Denaxas, Matt Keeling, and Sebastian Vollmer.
• Warwick Medical School, University of Warwick, Coventry, UK bilal.mateen@nhs.net.
• BMJ Open. 2021 Jan 26; 11 (1): e042945.

ObjectiveIn this study, we describe the pattern of bed occupancy across England during the peak of the first wave of the COVID-19 pandemic.DesignDescriptive survey.SettingAll non-specialist secondary care providers in England from 27 March27to 5 June 2020.ParticipantsAcute (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 MeasuresTwo thresholds for 'safe occupancy' were used: 85% as per the Royal College of Emergency Medicine and 92% as per NHS Improvement.ResultsAt 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.ConclusionsThroughout 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.© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

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