Post‑COVID‑19, many hospitals consistently operate at or near capacity, driven by persistent staffing shortages and increasing demand for care. That baseline strain leaves health systems with difficult operational decisions when seasonal respiratory viruses like influenza spike.
“On any given day when we look at our capacity trackers and we’re at 99% capacity and we’ve got 80 holds, you’re already running above normal threshold,” Wendy Woods-Swafford, MD, chief medical officer of UnityPoint Health-Des Moines, told Becker’s in a Jan. 15 interview. “When you’re already cranking the machine that hard, it doesn’t give you a lot of flexibility for influenza.”
That lack of flexibility prompted UnityPoint Health-Des Moines to delay elective surgeries and other procedures requiring overnight admission starting the week of Jan. 5, a decision Dr. Woods-Swafford said was difficult for leaders, who recognize that these interventions — despite being labeled “elective” — are far from optional for many patients. Such procedures often include necessary cardiac, oncology and other treatments that support long-term outcomes.
Ultimately, leaders decided they had to act, and delaying elective procedures was one of the few areas they could control, unlike emergency department volumes and unexpected trauma cases. The move came as the system saw record highs in patient holds and the number of people leaving the ED without being seen. Holds reflects both patients boarding in the ED and post-operative patients awaiting inpatient beds, Dr. Woods-Swafford said.
“It wasn’t just a record high, it was exponentially higher than it had been previously,” Dr. Woods-Swafford said. “I don’t know what it would have looked like if we had not made that decision.”
UnityPoint has also been working with its teams to spread the word about the surge in flu, encouraging community members to seek care through primary care providers or urgent care for nonemergencies to avoid further straining EDs. Internally, leaders emphasize the importance of physician engagement in capacity management, noting that better forecasting depends on clinical teams being involved in predicting daily movement and available bed space.
“It’s really all hands on deck when it comes to not just the operations side, but the physician side too,” Dr. Woods-Swafford said. “How much movement do they predict that we’re going to have today?”
Influenza has been pushing up admissions and ED volumes at hospitals across the country in recent weeks. More than 33,000 people in the U.S. were hospitalized with the flu during the week ending Dec. 27. The latest CDC FluView report — which reflects data through the week ending Jan. 10 — shows a slight drop, with more than 27,000 flu patients hospitalized.
UnityPoint Health-Des Moines had not yet resumed scheduling elective procedures during the week of Jan. 12, aiming to preserve flexibility amid uncertainty around respiratory virus-related surges over the next few weeks. Nationally, flu positivity fell slightly for the week ending Jan. 10, though experts say the timing of the season’s peak remains difficult to predict, given regional variability and shifting patterns in virus transmission.
Pre-pandemic, hospital officials could better predict how to direct resources and respond to shifts in patient volumes. Seasonal surges followed similar patterns, giving leaders time to plan, Dr. Woods-Swafford explained. That rhythm has since eroded, with capacity strain now a daily operational reality for many systems.
National data illustrates this shift: The number of mean staffed hospital beds has dropped from about 802,000 before the pandemic to 674,000 in the years since, according to JAMA Network Study published in 2025 led by researchers at the University of Los Angeles. Meanwhile, HHS data show hospital bed occupancy has consistently hovered above 70% since 2023.
These conflicting trends have pushed throughput and efficiency to the forefront for hospitals nationwide. Health systems are doubling down on enterprisewide strategies to reduce length of stay, streamline discharge planning and expand access to outpatient care.
At UnityPoint, flu cases declined the week of Jan. 12 compared to the week prior. While a welcome shift, the focus on capacity management will remain a daily effort well beyond flu season.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.