By Randi Pierce
Hospital capacity — both for COVID-19 and for other conditions — continues to be a concern across Colorado, as well as locally.
On Wednesday, San Juan Basin Public Health (SJBPH) Executive Director Liane Jollon reported there is zero ICU availability in the region, with every region in the state reporting ICU bed use at or above 100 percent.
She noted that means hospitals are surging and converting other types of hospital beds to try and offer more higher-level care.
“This is what we saw November last year,” she said, adding that at that time everyone was scrambling to make sure Colorado didn’t run out of hospital capacity. “We’re one year later facing the same thing.”
She noted there are concerns the state is on a trajectory to “completely overrun” health care resources.
In response to those hospital issues, Pagosa Springs Medical Center (PSMC) has moved to surge capacity “red.”
According to a statement from PSMC CEO Dr. Rhonda Webb, surge capacity “red” means that other hospitals in Colorado are unable (for a delay of two hours or more), to accept a transfer of a PSMC patient needing a higher level of care, whether for COVID or any other condition.
“This community is in a surge and as a result, PSMC is addressing the way it manages some patients to accommodate this surge,” Webb’s statement reads. “PSMC continues to provide services to the community but persons should be mindful that healthcare resources in Colorado hospitals and emergency services, including PSMC and its EMS, are currently strained.”
On Tuesday, the state reactivated crisis standards of care for staffing of health care systems throughout the state. Crisis standards of care are guidelines for how the medical community should allocate scarce resources.
“In this case, the state activated these guidelines specifically for staffing,” the press release notes. “Crisis standards of care for staffing of health care systems allows hospitals to implement staffing solutions to best meet the increasing medical needs of their communities. Upon activation, these crisis standards of care for staffing of health care systems may be implemented to best manage the current influx of patients who need care for COVID-19 or any other illness.”
According to the press release, the public health objectives are to: “Expand the availability of health care workers and health care resources to combat the COVID-19 pandemic and to serve patients seeking non-COVID-19 related care;” and “Assure that guardrails and supports are in place to optimize workplace safety, health care worker resilience in the face of moral and physical stress, patient safety, and health outcomes of COVID-19 and non-COVID-19 patients.”
“We want to be sure Coloradans know they can and should continue to access necessary health care. If you’re sick and need care, please go get it,” said Dr. Eric France, Colorado’s chief medical officer, via the press release. “Activating staffing crisis standards of care allows health care systems to maximize the care they can provide in their communities with the staff they have available.”
In another move addressing hospital capacity, Gov. Jared Polis recently issued Executive Order D 2021-135, which authorizes the Colorado Department of Public Health and Environment (CDPHE) to direct facilities to transfer patients to prevent overwhelming the capacity of a facility and its staff. Hospitals can transfer patients that aren’t COVID-19 patients if that helps address capacity needs.
According to the press release, “Hospitals are required (by federal law) to accept a transfer if they are able to provide the level of care needed and if they have capacity. Transfers are evaluated on a case-by-case basis to ensure Colorado has capacity and can provide the care required. A hospital must comply with the non-waived sections of the EMTALA (Emergency Medical Treatment and Labor Act), including the requirements to provide stabilizing treatment within the hospital’s capabilities and capacity prior to the initiation of a transfer to another hospital, and to provide a medical screening examination to any individual who comes to the emergency department and requests examination or treatment.”
The press release also discusses the stress on health care workers throughout the pandemic.
“Health care workers have been at the forefront of the COVID-19 response for more than 20 months,” it notes. “Staff shortages due to COVID-19 illness, increased workloads due to hospitals working at capacity, and staff burnout are all making working conditions difficult and often outside the scope of conventional care. Health care systems must notify CDPHE when they activate and deactivate crisis standards of care for staffing.”
The press release notes the state is not at this time activating crisis standards of care for emergency medical services, hospital and acute care facilities, out-of-hospital care providers, specialty patient populations or personal protective equipment.