Methodology

The analysis of the data on the understaffing of COVID ICUs, mortality and Greek hospital occupancy

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The collection, processing and analysis of the data on the understaffing of COVID ICUs, the mortality and hospital occupancy, during the “second wave” of the pandemic in Greece.

Data sources

For the analysis regarding the (under)staffing of the COVID-19 ICUs, have been used primary data from 51 COVID-19 ICUs in 41 hospitals across Greece, provided by the Hellenic Society of Intensive Care Medicine (HSICM) to the iMEdD Lab. Their recording period extends from January 28, 2021 to February 18, 2021. The primary data are included in a .pdf file and presented in a five-column table, as described below.

  • Hospital: each hospital under study
  • COVID ICU beds: ICU under study and the corresponding number of beds
  • Doctors: number of doctors on duty per ICU under study –in many cases special notes are included on the number of both auxiliary and seconded doctors, and those serving in the COVID-19 ICUs due to the current needs, who are not specialized in intensive care (residents, those transferred from other departments and so on).
  • Nurses: number of nurses on duty per ICU under study –as with the medical personnel, in many cases, special notes are included on the number of nurses recorded in the total amount of personnel, who offer auxiliary services although they are not specialized in intensive care (transferred from other departments, trainees, etc.)
  • Health District: the health district to which the respective hospital under study belongs

These data, provided by the HSICM to the iMEdD Lab, have subsequently been supplemented with additional information for the Department of Respiratory Deficiency (DRD), the 1st ICU and the 2nd ICU (former COVID) of Papanikolaou Hospital in Thessaloniki, according to the statement of the Department Manager of the Intensive Care Unit and Coordinating Director of the 2nd ICU, Nikos Kapravelos, at the iMEdD Lab.

The following information is used for data analysis, regarding the relationship between local mortality and occupancy in the Greek Health System per Health District, during the second “wave” of the pandemic in Greece:

  • The latest data on the available and occupied beds, in ICUs and in total, per Health District, which were disclosed by the Ministry of Health, as an informal briefing via e-mail to the Press, on November 20, 2020.
  • The data on the geographical distribution of total losses, since the beginning of the pandemic, published by the iMEdD Lab in mid-December: they regard the distribution of 3,214 deaths per Regional Unit, a sample that corresponds to 87% of the 3,687 total losses by December 14, 2020.
  • Calculated population figures per Regional Unit on January 1st, 2019, which the Hellenic Statistical Authority (ELSTAT) provided, upon request, to the iMEdD Lab.

Processing and analysis of data

Using the Tabula tool, we converted the table with the primary data for the beds and the respective medical personnel per ICU under study, which we had originally received from the HSICM in a .pdf file to a .csv file. Then, with the use of spreadsheets, we proceeded to produce two different files for the medical and nursing personnel respectively. Each of them, after cleaning the quantitative data and removing the textual information, was developed as shown in the tables below.

Beds and nursing personnel per COVID ICU under study

ΥΠΕype_labelype_label_enhoverlabelhoverlabel_enicu_bedsnurs_threshnurses_totalnurses_netnurses_total_beds_rationurses_net_beds_ratio
1η ΥΠΕ – ΑττικήςAtticaΕυαγγελισμόςEvangelismos4417613013033
1η ΥΠΕ – ΑττικήςAtticaΣωτηρία, Α ́ Παν/κή Πνευματολογική ΜΕΘSotiria, 1st Uni Pneumatological ICU176843432,52,5
1η ΥΠΕ – ΑττικήςAtticaΣωτηρία, Πολυδύναμη ΜΕΘ, ΜΕΘ 1Sotiria, Multifunctional ICU, 1st ICU135238382,92,9
1η ΥΠΕ – ΑττικήςAtticaΣωτηρία, Πολυδύναμη ΜΕΘ, ΜΕΘ 2Sotiria, Multifunctional ICU, 2nd ICU124837373,13,1
1η ΥΠΕ – ΑττικήςAtticaΣωτηρία, Πολυδύναμη ΜΕΘ, ΜΕΘ 3Sotiria, Multifunctional ICU, 3rd ICU135237372,82,8
1η ΥΠΕ – ΑττικήςAtticaΣωτηρία, Πολυδύναμη ΜΕΘ, ΜΕΘ 4Sotiria, Multifunctional ICU, 4th ICU124835352,92,9
1η ΥΠΕ – ΑττικήςAtticaΠαν. & Αγλ. ΚυριακούPan. & Agl. Kyriakou52029295,85,8
1η ΥΠΕ – ΑττικήςAtticaΓ. ΓεννηματάςG. Gennimatas176846462,72,7
2η ΥΠΕ – Πειραιώς & ΑιγαίουPiraeus & AegeanΘριάσιοThriasio124845453,83,8
2η ΥΠΕ – Πειραιώς & ΑιγαίουPiraeus & AegeanΑσκληπιείοAsclepeion124835282,92,3
2η ΥΠΕ – Πειραιώς & ΑιγαίουPiraeus & AegeanΑττικόνAttikon176850402,92,4
2η ΥΠΕ – Πειραιώς & ΑιγαίουPiraeus & AegeanΓΝ ΜυτιλήνηςGen. Hosp. Mytilene31220206,76,7
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓΝ Κοζάνης, ΜαμάτσειοGen. Hosp. Kozani, Mamatseio31219106,33,3
3η ΥΠΕ – ΜακεδονίαςMacedoniaΠαπαγεωργίουPapageorgiou187259433,32,4
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓΝ ΓιαννιτσώνGen. Hosp. Giannitsa83225253,13,1
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓΝ ΚατερίνηςGen. Hops. Katerini72820202,92,9
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓ. ΓεννηματάςG. Gennimatas, Thessaloniki176842232,51,4
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓ. Παπανικολάου, Α ΜΕΘG. Papanikolaou, 1st ICU1872544832,7
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓ. Παπανικολάου, ΚΑΑG. Papanikolaou, Respiratory Failure Clinic728281842,6
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓ. Παπανικολάου, ΜΕΘ ΕγκαυμάτωνG. Papanikolaou, Burn ICU6240000
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓ. Παπανικολάου, Β ΜΕΘG. Papanikolaou, 2nd ICU124830302,52,5
3η ΥΠΕ – ΜακεδονίαςMacedoniaΑγ. ΔημήτριοςAgios Dimitrios83200
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓΝ ΧαλκιδικήςGen. Hosp. Chalkidiki1144111111
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΠαν/κό ΓΝ ΑλεξανδρούποληςUni Gen. Hosp. Alexandroupoli93635353,93,9
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΙπποκράτειοIppokrateio83218182,32,3
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΙπποκράτειο, ΜΕΘ ΠαίδωνIppokrateio, Children ICU288844
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΑΧΕΠΑ, ΜΕΘ 1ΑΗΕPΑ, 1st ICU166434342,12,1
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΑΧΕΠΑ, ΜΕΘ 2AXEPA, 2nd ICU416121233
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΓΝ ΣερρώνGen. Hosp. Serres145632292,32,1
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΑγ. ΠαύλοςAgios Pavlos83245455,65,6
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΓΝ ΞάνθηςGen. Hosp. Xanthi72819192,72,7
5η ΥΠΕ – Θεσσαλίας & Στερεάς ΕλλάδαςThessaly & Central GreeceΓΝ ΛαμίαςGen. Hosp. Lamia1248363633
5η ΥΠΕ – Θεσσαλίας & Στερεάς ΕλλάδαςThessaly & Central GreeceΓΝ Βόλου, ΑχιλλοπούλειοGen. Hosp. Volos, Achilopouleio83220152,51,9
5η ΥΠΕ – Θεσσαλίας & Στερεάς ΕλλάδαςThessaly & Central GreeceΓΝ Λάρισας, ΚουτλιμπάνειοGen. Hosp. Larissa, Koutlibaneio1664646444
5η ΥΠΕ – Θεσσαλίας & Στερεάς ΕλλάδαςThessaly & Central GreeceΠαν/κό ΓΝ ΛάρισαςUni Gen. Hosp. Larissa187260383,32,1
6η ΥΠΕ – Πελοποννήσου, Ιονίων Νήσων, Ηπείρου & Δυτικής ΕλλάδαςPeloponnese, Ionian Islands, Epirus & Western GreeceΓΝ Ιωαννίνων, ΧατζηκώσταGen. Hosp. Ioannina, G. Hatzikostas416161644
6η ΥΠΕ – Πελοποννήσου, Ιονίων Νήσων, Ηπείρου & Δυτικής ΕλλάδαςPeloponnese, Ionian Islands, Epirus & Western GreeceΠαν/κό ΓΝ Ιωαννίνων, ΜΕΘ ΑUni Gen. Hosp. Ioannina, 1st ICU83219192,42,4
6η ΥΠΕ – Πελοποννήσου, Ιονίων Νήσων, Ηπείρου & Δυτικής ΕλλάδαςPeloponnese, Ionian Islands, Epirus & Western GreeceΠαν/κό ΓΝ Ιωαννίνων, ΜΕΘ ΒUni Gen. Hosp. Ioannina, 2nd ICU83221212,62,6
6η ΥΠΕ – Πελοποννήσου, Ιονίων Νήσων, Ηπείρου & Δυτικής ΕλλάδαςPeloponnese, Ionian Islands, Epirus & Western GreeceΓΝ ΚέρκυραςGen. Hosp. Corfu62423233,83,8
6η ΥΠΕ – Πελοποννήσου, Ιονίων Νήσων, Ηπείρου & Δυτικής ΕλλάδαςPeloponnese, Ionian Islands, Epirus & Western GreeceΠαν/κό ΓΝ Πατρών, Α ΜΕΘUni Gen. Hosp. Patras, 1st ICU62415152,52,5
6η ΥΠΕ – Πελοποννήσου, Ιονίων Νήσων, Ηπείρου & Δυτικής ΕλλάδαςPeloponnese, Ionian Islands, Epirus & Western GreeceΠαν/κό ΓΝ Πατρών, Β ΜΕΘUni Gen. Hosp. Patras, 2nd ICU62419193,23,2
6η ΥΠΕ – Πελοποννήσου, Ιονίων Νήσων, Ηπείρου & Δυτικής ΕλλάδαςPeloponnese, Ionian Islands, Epirus & Western GreeceΠαν/κό ΓΝ Πατρών, ΜΕΘ ΠαίδωνUn Gen. Hosp. Patras, Children ICU2813136,56,5
6η ΥΠΕ – Πελοποννήσου, Ιονίων Νήσων, Ηπείρου & Δυτικής ΕλλάδαςPeloponnese, Ionian Islands, Epirus & Western GreeceΓΝ Πατρών, Αγ. ΑνδρέαςGen. Hosp. Patras, Agios Andreas83222222,82,8
7η ΥΠΕ – ΚρήτηςCreteΓΝ ΡεθύμνουGen. Hosp. Rethymno3120000
7η ΥΠΕ – ΚρήτηςCreteΠαν/κό ΓΝ ΗρακλείουUni Gen. Hosp. Hraklion1664323222
7η ΥΠΕ – ΚρήτηςCreteΠαν/κό ΓΝ Ηρακλείου, ΜΕΘ ΠαίδωνUni Gen. Hosp. Hraklion, Children ICU28121266
7η ΥΠΕ – ΚρήτηςCreteΓΝ Χανίων, Αγ. ΓεώργιοςGen. Hosp. Chania, Agios Georgios72820202,92,9
7η ΥΠΕ – ΚρήτηςCreteΓΝ Αγ. ΝικολάουGen. Hosp. Agios Nikolaos312220,70,7
Στρατιωτικά Νοσ/μείαΣτρατιωτικά Νοσ/μείαMilitary Hospitals251 ΓΝΑ251 Air Force Gen. Hosp.312121244
Στρατιωτικά Νοσ/μείαΣτρατιωτικά Νοσ/μείαMilitary HospitalsΝΝΑ ΑθηνώνAthens Naval Hospital41622225,55,5
Στρατιωτικά Νοσ/μείαΣτρατιωτικά Νοσ/μείαMilitary Hospitals417 ΝΙΜΤΣ417 Army Pension Fund Hospital41617174,34,3
Data source: HSICM / Also includes data for the 2nd ICU (former COVID) of Papanikolaou Hospital in Thessaloniki, according to a statement by Department Manager of the Intensive Care Unit and Coordinating Director of the 2nd ICU, Nikos Kapravelos.

Ratio of specialized personnel per ICU bed

  • <iframe src="https://lab.imedd.org/iframes/covid_graphics/icu_nurses_net_en/index.html" height="400" width="100%" allow="fullscreen"></iframe>

The above table, which was the main body of data on which the analyses on the staffing of COVID ICUs with nursing personnel are based, includes the following variables:

  • ΥΠΕ: reference health district
  • ype_label: label for the reference Health District in Greek
  • ype_label_en: label for the reference Health District in English
  • hoverlabel: label for the reference ICU in Greek –in the form of “Hospital, ICU”, for the cases of multiple ICUs under study in the same hospital
  • hoverlabel_en: label for the reference ICU in English –also in the form of “Hospital, ICU”, for cases of multiple ICUs under study in the same hospital
  • icu_beds: number of beds in the reference COVID ICU
  • nurs_thresh: estimated required total number of nurses per ICU under study, based on the minimum requirement for operation which is specified as four –trained in intensive care and emergency medicine– nurses per ICU bed, according to the unanimous decision of the Central Board of Health (KESY, 2016)
  • nurses_total: total amount of nursing personnel on duty, as stated in the primary data provided to us
  • nurses_net: estimated amount of nursing personnel specialized in intensive care –is obtained by subtracting the personnel that is supposed to serve in support, without being specialized in intensive care (transferred from other departments, trainees, etc.) from the total number of nurses on duty, provided that this is clearly stated in the special notes of the units in the data provided to us
  • nurses_total_beds_ratio: ratio of total nursing personnel per bed
  • nurses_net_beds_ratio: ratio of estimated specialized nursing personnel per bed

Beds and medical personnel per COVID ICU under study

ΥΠΕype_labelype_label_enhoverlabelhoverlabel_enicu_bedsdoct_threshdoct_totaldoct_netdoct_total_beds_ratiodoct_net_beds_ratio
1η ΥΠΕ – ΑττικήςAtticaΕυαγγελισμόςEvangelismos441824240,50,5
1η ΥΠΕ – ΑττικήςAtticaΣωτηρία, Α ́ Παν/κή Πνευματολογική ΜΕΘSotiria, 1st Uni Pneumatological ICU17915120,90,7
1η ΥΠΕ – ΑττικήςAtticaΣωτηρία, Πολυδύναμη ΜΕΘ, ΜΕΘ 1Sotiria, Multifunctional ICU, 1st ICU138960,70,5
1η ΥΠΕ – ΑττικήςAtticaΣωτηρία, Πολυδύναμη ΜΕΘ, ΜΕΘ 2Sotiria, Multifunctional ICU, 2nd ICU127860,70,5
1η ΥΠΕ – ΑττικήςAtticaΣωτηρία, Πολυδύναμη ΜΕΘ, ΜΕΘ 3Sotiria, Multifunctional ICU, 3rd ICU138980,70,6
1η ΥΠΕ – ΑττικήςAtticaΣωτηρία, Πολυδύναμη ΜΕΘ, ΜΕΘ 4Sotiria, Multifunctional ICU, 4th ICU127850,70,4
1η ΥΠΕ – ΑττικήςAtticaΠαν. & Αγλ. ΚυριακούPan. & Agl. Kyriakou5610821,6
1η ΥΠΕ – ΑττικήςAtticaΓ. ΓεννηματάςG. Gennimatas17919191,11,1
2η ΥΠΕ – Πειραιώς & ΑιγαίουPiraeus & AegeanΘριάσιοThriasio1271361,10,5
2η ΥΠΕ – Πειραιώς & ΑιγαίουPiraeus & AegeanΑσκληπιείοAsclepeion12712910,8
2η ΥΠΕ – Πειραιώς & ΑιγαίουPiraeus & AegeanΑττικόνAttikon17923231,41,4
2η ΥΠΕ – Πειραιώς & ΑιγαίουPiraeus & AegeanΓΝ ΜυτιλήνηςGen. Hosp. Mytilene346622
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓΝ Κοζάνης, ΜαμάτσειοGen. Hosp. Kozani, Mamatseio34732,31
3η ΥΠΕ – ΜακεδονίαςMacedoniaΠαπαγεωργίουPapageorgiou18914100,80,6
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓΝ ΓιαννιτσώνGen. Hosp. Giannitsa86530,60,4
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓΝ ΚατερίνηςGen. Hops. Katerini76650,90,7
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓ. Γεννηματάς (Θεσ/νίκης)G. Gennimatas, Thessaloniki17920191,21,1
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓ. Παπανικολάου, Α ΜΕΘG. Papanikolaou, 1st ICU1891390,70,5
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓ. Παπανικολάου, ΚΑΑG. Papanikolaou, Respiratory Failure Clinic7614721
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓ. Παπανικολάου, ΜΕΘ ΕγκαυμάτωνG. Papanikolaou, Burn ICU660000
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓ. Παπανικολάου, Β ΜΕΘG. Papanikolaou, 2nd ICU1271090,80,8
3η ΥΠΕ – ΜακεδονίαςMacedoniaΑγ. ΔημήτριοςAgios Dimitrios86750,90,6
3η ΥΠΕ – ΜακεδονίαςMacedoniaΓΝ ΧαλκιδικήςGen. Hosp. Chalkidiki117730,60,3
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΠαν/κό ΓΝ ΑλεξανδρούποληςUni Gen. Hosp. Alexandroupoli961191,21
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΙπποκράτειοIppokrateio86991,11,1
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΙπποκράτειο, ΜΕΘ ΠαίδωνIppokrateio, Children ICU244321,5
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΑΧΕΠΑ, ΜΕΘ 1ΑΗΕPΑ, 1st ICU20101550,80,3
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΓΝ ΣερρώνGen. Hosp. Serres148660,40,4
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΑγ. ΠαύλοςAgios Pavlos86981,11
4η ΥΠΕ – Μακεδονίας & ΘράκηςMacedonia & ThraceΓΝ ΞάνθηςGen. Hosp. Xanthi76220,30,3
5η ΥΠΕ – Θεσσαλίας & Στερεάς ΕλλάδαςMacedonia & ThraceΓΝ ΛαμίαςGen. Hosp. Lamia127440,30,3
5η ΥΠΕ – Θεσσαλίας & Στερεάς ΕλλάδαςThessaly & Central GreeceΓΝ Βόλου, ΑχιλλοπούλειοGen. Hosp. Volos, Achilopouleio868710,9
5η ΥΠΕ – Θεσσαλίας & Στερεάς ΕλλάδαςThessaly & Central GreeceΓΝ Λάρισας, ΚουτλιμπάνειοGen. Hosp. Larissa, Koutlibaneio1691260,80,4
5η ΥΠΕ – Θεσσαλίας & Στερεάς ΕλλάδαςThessaly & Central GreeceΠαν/κό ΓΝ ΛάρισαςUni Gen. Hosp. Larissa189181210,7
6η ΥΠΕ – Πελοποννήσου, Ιονίων Νήσων, Ηπείρου & Δυτικής ΕλλάδαςThessaly & Central GreeceΓΝ Ιωαννίνων, ΧατζηκώσταGen. Hosp. Ioannina, G. Hatzikostas46771,81,8
6η ΥΠΕ – Πελοποννήσου, Ιονίων Νήσων, Ηπείρου & Δυτικής ΕλλάδαςPeloponnese, Ionian Islands, Epirus & Western GreeceΠαν/κό ΓΝ Ιωαννίνων, ΜΕΘ ΑUni Gen. Hosp. Ioannina, 1st ICU169850,50,3
6η ΥΠΕ – Πελοποννήσου, Ιονίων Νήσων, Ηπείρου & Δυτικής ΕλλάδαςPeloponnese, Ionian Islands, Epirus & Western GreeceΓΝ ΚέρκυραςGen. Hosp. Corfu66550,80,8
6η ΥΠΕ – Πελοποννήσου, Ιονίων Νήσων, Ηπείρου & Δυτικής ΕλλάδαςPeloponnese, Ionian Islands, Epirus & Western GreeceΠαν/κό ΓΝ Πατρών, Α ΜΕΘUni Gen. Hosp. Patras, 1st ICU1271190,90,8
6η ΥΠΕ – Πελοποννήσου, Ιονίων Νήσων, Ηπείρου & Δυτικής ΕλλάδαςPeloponnese, Ionian Islands, Epirus & Western GreeceΠαν/κό ΓΝ ΠΑτρών, Β ΜΕΘUni Gen. Hosp. Patras, 2nd ICU24552,52,5
6η ΥΠΕ – Πελοποννήσου, Ιονίων Νήσων, Ηπείρου & Δυτικής ΕλλάδαςPeloponnese, Ionian Islands, Epirus & Western GreeceΓΝ Πατρών, Αγ. ΑνδρέαςGen. Hosp. Patras, Agios Andreas86440,50,5
7η ΥΠΕ – ΚρήτηςCreteΓΝ ΡεθύμνουGen. Hosp. Rethymno340000
7η ΥΠΕ – ΚρήτηςCreteΠαν/κό ΓΝ ΗρακλείουUni Gen. Hosp. Hraklion169161611
7η ΥΠΕ – ΚρήτηςCreteΠαν/κό ΓΝ Ηρακλείου, ΜΕΘ ΠαίδωνUni Gen. Hosp. Hraklion, Children ICU246633
7η ΥΠΕ – ΚρήτηςCreteΓΝ Χανίων, Αγ. ΓεώργιοςGen. Hosp. Chania, Agios Georgios76871,11
7η ΥΠΕ – ΚρήτηςCreteΓΝ Αγ. ΝικολάουGen. Hosp. Agios Nikolaos34110,30,3
Στρατιωτικά Νοσ/μείαΣτρατιωτικά Νοσ/μείαMilitary Hospitals251 ΓΝΑ251 Air Force Gen. Hosp.34882,72,7
Στρατιωτικά Νοσ/μείαΣτρατιωτικά Νοσ/μείαMilitary HospitalsΝΝΑ ΑθηνώνAthens Naval Hospital461373,31,8
Στρατιωτικά Νοσ/μείαΣτρατιωτικά Νοσ/μείαMilitary Hospitals417 ΝΙΜΤΣ417 Army Pension Fund Hospital46551,31,3
Data source: HSICM. Also includes additional information for the DRD, the 1st ICU and the 2nd ICU (former COVID) of Papanikolaou Hospital in Thessaloniki, according to the statement of the Department Manager of the Intensive Care Unit and Coordinating Director of the 2nd ICU, Nikos Kapravelos, at the iMEdD Lab.

The above table, which was the main body of data on which the analyses on the staffing of COVID ICUs with medical personnel are based, in addition to the aforementioned regarding Health Districts, ICUs under study and corresponding available beds, includes the following variables:

  • doct_thresh: estimated required total number of doctors per ICU under study. This is calculated with the following formula doct_thresh = 6+((icu_beds-8)/3) and is based on the unanimous decision of KESY (2016): according to the latter, at least six doctors, with the required specialization for intensive care, for eight ICU beds are “necessary for the safe and unobstructed operation of the unit”, while for ICUs larger than eight beds, the proportion of the number of doctors should be one doctor for every three extra beds. “In ICUs with four to six beds, the medical personnel cannot be comprised by less than six people, in order to cover on call duties” the same decision states.
  • doct_total: total amount of medical personnel on duty, as stated in the primary data provided to us
  • doct_net: estimated amount of permanent medical personnel –is obtained by subtracting the personnel that is supposed to serve in support, without being specialized in intensive care (auxiliary doctors, seconded employees, transferred from other departments, trainees, etc.) from the total number of doctors on duty, provided that this is clearly stated in the special notes of the units in the data provided to us
  • doct_total_beds_ratio: ratio of total medical personnel per bed
  • doct_net_beds_ratio: ration of estimated permanent medical personnel per bed

The analysis of the sample in terms of staffing of the units was, therefore, guided by the decision of KESY (2016) and is presented with a focus, on the one hand, on the individual ratios of healthcare personnel per bed at the ICUs under study and, on the other hand, on the consequent median ratio of healthcare workforce per bed at Health District level. Absolute numbers should be read with extreme caution in an ever-changing situation, the data of which are not sufficiently communicated by the Authorities. In particular, the competent bodies have never, to date, disclosed data on the staffing of hospitals during the pandemic, adding to the fragmentary, periodic, update regarding the existing infrastructure: the Ministry of Health proceeded to regular briefings regarding the available and occupied beds, per Health District, for COVID-19 cases only in the period from November 13 to November 20, 2020. There has been no regular release of data since, and there has been no response to the repeated requests from the iMEdD Lab to the Ministry of Health.

Mortality and hospital occupancy during the second “wave” of the pandemic in Greece

  • <iframe src="https://lab.imedd.org/iframes/covid_graphics/mortality_occupancy_en/index.html" height="550" width="100%" allow="fullscreen"></iframe>

Also with the use of spreadsheets, we grouped, the above-mentioned data at the level of Health Districts, on the one hand, on total losses from the disease until mid-December 2020 and, on the other hand, on the estimated population. We then combined these data with those disclosed by the Ministry of Health about beds, total amount and ICU (November 20, 2020) –ending up with the following table, based on which we created the graph of mortality and occupancy during the second “wave” of the pandemic in Greece.

Mortality (until mid-December 2020) and ICU beds (November 20, 2020) per Health District

ype_labelype_label_enestimated_populationaggregated_deathsmortality_per_100ktotal_bedstotal_beds_occupiedicu_bedsicu_beds_occupied
Attica324341855317,051201621167128
Piraeus & Aegean108949014413,224812675339
Macedonia1782343139978,491309984138137
Macedonia & Thrace94346169673,7716701250137125
Thessaly & Central Greece125984733326,436184987371
Peloponnese, Ionian Islands, Epirus, Western Greece17711101397,856372484724
Crete634930203,15241651814
Στρατιωτικά Νοσ/μείαMilitary Hospitals2051461817
Data sources: Ministry of Health for available and occupied beds (11/20/2020), iMEdD Lab for the geographical distribution of deaths (until mid-December 2020)
 
for i,item in do.iterrows():
    fig.add_shape(dict(
            type='line',
            x0=item['doct_thresh'],
            y0=item.hoverlabel,
            x1=item['doct_net'],
            y1=item.hoverlabel,
            line=dict(
                color='#768948' if item.doct_net-item.doct_thresh >0 else '#BA3A0B',
                width=2
            ),
            layer='below',
            visible=True
    ))
Code snippet for the creation of the range plot.

Part of the overall data processing and analysis was done using Python and the open library pandas.

Visualization of the analysis

The diagrams for the visualization of the analysis were created using the open source library Plotly Python.

Particularly for the visualization of the staffing of COVID-19 ICU beds with medical personnel, it was deemed appropriate to be done in the form of a range plot, to make obvious whether each of the ICUs included in our sample meets the minimum requirement for operation or is falling short, according to the information provided. For this purpose, firstly were created scatter plots, depicting the minimum required number of doctors and the declared number of doctors on duty per ICU under study. Subsequently, an equal number of lines were created, which have as starting and ending points the said numbers of doctors, minimum required and on duty respectively. Thus, the distance between the two, indicates the degree of meeting the needs or understaffing.

Staffing of COVID-19 ICU beds with medical personnel (non-specialized or emergency support personnel included)

  • <iframe src="https://lab.imedd.org/iframes/covid_graphics/icu_doctors_total_en/index.html" height="870" width="100%" allow="fullscreen"></iframe>
Data source: HSICM. Includes information on the 417 NIMTS military hospital, which now operates exclusively for cases other than COVID-19. Also includes information for the 2nd ICU (former COVID) of Papanikolaou Hospital in Thessaloniki, according to the statement of the Department Manager of the Intensive Care Unit and Coordinating Director of the 2nd ICU, Nikos Kapravelos, at the iMEdD Lab.

Translation: Evita Lykou

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