{"id":42691,"date":"2022-01-16T11:00:00","date_gmt":"2022-01-16T18:00:00","guid":{"rendered":"https:\/\/dh.durangoherald.com\/tj\/er-doctors-sound-alarm-as-colorados-hospital-system-shows-cracks-from-omicron-wave\/"},"modified":"2022-01-16T18:00:00","modified_gmt":"2022-01-16T18:00:00","slug":"er-doctors-sound-alarm-as-colorados-hospital-system-shows-cracks-from-omicron-wave","status":"publish","type":"post","link":"https:\/\/dh.durangoherald.com\/tj\/er-doctors-sound-alarm-as-colorados-hospital-system-shows-cracks-from-omicron-wave\/","title":{"rendered":"ER doctors sound alarm as Colorado\u2019s hospital system shows cracks from omicron wave"},"content":{"rendered":"\n

\"UCHealth
UCHealth Greeley Hospital in Greeley, Colorado, on Wednesday, October 13, 2021. (Hart Van Denburg\/CPR News)<\/span>cca<\/span><\/figcaption><\/figure>\n<\/p>

Cracks in Colorado\u2019s hospital system are starting to appear, after weeks of dire warnings about the impact of back-to-back punches from the coronavirus, delivered by the delta and omicron variants during a time when health care workers are not only getting infected by but exhausted from nearly two full years of the pandemic.<\/p>\n

Doctors and health experts are calling on the state to act, while hospitals are enacting their own policies to try to weather a wave of patients needing care from depleted emergency departments.<\/p>\n

For instance, the UCHealth system adopted new rules in its emergency department last week about who will be admitted and what kind of care they receive. The rules are meant to ease pressure on the system and the staff by lowering the number of people who need acute care.<\/p>\n

Despite the challenges, the state, hospitals and emergency physicians are united in urging Coloradans to seek, and not put off, emergency care if they need it.<\/p>\n

To date, the Polis administration has not activated crisis standards of care for hospitals, far-reaching emergency protocols aimed to help them deal with the crisis. But just this week, emergency room physicians met with top leaders of the state\u2019s pandemic response and the governor\u2019s staff urging just that. The 700-strong Colorado chapter of The American College of Emergency Physicians followed that up with a letter to the governor\u2019s office Friday that put the crisis in stark terms.<\/p>\n

\u201cAs our health care system continues to struggle with multiple stressors on the system, we are at a breaking point,\u201d the letter, written from talking points delivered to the governor\u2019s office via Zoom call Tuesday, stated. \u201cWe are currently dealing with conditions that have never been seen before in our state.\u201d<\/p>\n

ERs doctors lay out serious issues<\/div>\n

\u201cWe need your help ASAP!\u201d the doctors wrote. Their first request to the governor\u2019s team was for better communication from the state about when to seek care in the ED for COVID-19 or other illnesses and injuries, where to seek care rather than testing and more information about seeking monoclonal antibody treatment. It also asked for more transparency on hospital reporting of staffed bed availability.<\/p>\n

The group laid out a series of serious issues now plaguing the health care system: nursing shortages, a lack of access to rapid testing, significant liability risks for clinicians and hospitals now caring for patients, challenges in transferring patients statewide when hospitals are full and the anticipation, in coming weeks, of more patients coming to emergency departments to seek additional new oral medications to treat COVID-19.<\/p>\n

\u201cWe are in a crisis. And the thing about it is that this is a crisis that\u2019s now, and it\u2019s about to get worse,\u201d said Dr. Ricky Dhaliwal, the group\u2019s president, who is an emergency doctor at Sky Ridge Medical Center in Lone Tree. \u201cThe wait-and-see approach just I don\u2019t think is a smart way to do this.\u201d<\/p>\n

Making matters worse, he said, is the numbers and proportion of health care workers getting sick with COVID-19, complicating hospitals\u2019 ability to care for patients and presenting vexing problems for staffing.<\/p>\n

\u201cIt\u2019s all over the place. It\u2019s droves of people getting COVID,\u201d he said.<\/p>\n

Dhaliwal said one concern state officials brought up was whether adopting statewide hospital crisis standards would create fear in patients of seeking emergency care.<\/p>\n

The governor\u2019s office hadn\u2019t yet responded to a request for comment at the time of publication. A spokesman for the state health department said earlier Friday afternoon, the state had no plans and hoped to not have to activate hospital crisis standards of care.<\/p>\n

Hospitals as busy as ever<\/div>\n

The call from the ER doctors and UCHealth\u2019s move comes as the omicron variant drives up high numbers of COVID-19 cases and a lot of people are seeking care for all kinds of other reasons as well.<\/p>\n

\u201cI don\u2019t want anybody to be dissuaded from seeking emergency care. That is not where we are. We are not in a position where we cannot care for people who have emergency medical conditions. We are well capable and well-staffed of doing that,\u201d said Dr. Richard Zane, the director of emergency services at UCHealth. \u201cThe reason we\u2019re doing this is so we can continue to care for patients with emergency medical conditions.\u201d<\/p>\n

The move is critical, he said, in order for the system to be available for \u201cthe 22-year-old with the acute leukemia or the very sick COVID patient or the trauma patient, or the very sick myocardial infarction patient. We are essentially screening the low acuity patients who do not have emergencies and need an emergency department that day.\u201d<\/p>\n

He said if the University of Colorado Hospital emergency department in Aurora typically sees between 300 and 325 patients on an exceptionally busy day, now it\u2019s seeing well over 400 patients per day. But it\u2019s not just the number of patients that led the department to release new guidelines.<\/p>\n

\u201cWe have much more volume, but contextually there\u2019s a staffing volume mismatch. I do not have staff to augment up to be able to care for over 400 patients per day,\u201d he said.<\/p>\n

Even so, that does not mean that people with medical emergencies are turned away. ERs are strained but are still able to treat emergencies like heart attacks, strokes or serious injuries.<\/p>\n

Moving ahead with crisis care policies<\/div>\n

\u201cEvery patient who has an emergency medical condition is going to get care. I think that\u2019s really important,\u201d said spokesman Dan Weaver, UCH\u2019s vice president for communications.<\/p>\n

Zane said UCHealth emergency departments will be providing a medical screening exam for all patients upon arrival and if they don\u2019t meet criteria for an emergency medical condition, they\u2019ll be discharged with outpatient follow up recommendations.<\/p>\n

\u201cYou can be seen by your primary care physician tomorrow, or get testing as an outpatient. So although it\u2019s not convenient news, it\u2019s good news,\u201d he said.<\/p>\n

It means simply that medical staff don\u2019t consider you sick enough to need emergency care.<\/p>\n

\u201cIn very high volume situations, those who are stable and who will not have negative health impacts if they are not admitted may be referred to other local care providers such as urgent care locations,\u201d said Brian Spencer, a spokesman for the state\u2019s Joint Information Center. \u201cThis ensures available emergency department resources are being used to best care for those presenting with emergent conditions.\u201d<\/p>\n

He said when somebody arrives at a hospital, hospitals must comply with federal rules about emergency medical care. That includes requirements to provide stabilizing treatment within the hospital\u2019s capabilities and capacity before someone is transferred to another hospital, and to provide a medical screening examination to anyone who comes to the emergency department.<\/p>\n

Similar guidelines about emergency department patients have been activated at University of Colorado Hospital in Aurora as well as some of the system\u2019s other facilities, including Highlands Ranch, Memorial Hospital in Colorado Springs, Memorial North, and for a brief period of time, Grandview Hospital.<\/p>\n

\u201cIt\u2019s evaluated hour by hour by definition and essentially can be turned on or off,\u201d said Zane. \u201cWe must maintain the ability to care for the high acuity tertiary kinds of patients that only we can care for. And that\u2019s a very important point for us.\u201d<\/p>\n

State hits 11,000 deaths due to COVID<\/div>\n

Statewide, hospitalizations of confirmed COVID-19 patients rose to 1,663 Friday, according to the state dashboard. That\u2019s the highest level in more than a year and now within 200 away from the all-time pandemic peak of 1,847 in December 2020. At the current pace that peak could be surpassed in the coming days.<\/p>\n

More than half of hospitals anticipate a staffing shortage in the next week and about a third say they expect to have a shortage of intensive care beds.<\/p>\n

Ninety-one percent of the state\u2019s intensive care hospital beds are in use. That compares with 65 percent at the start of the pandemic in April 2020. As of Thursday, there were 135 available ICU beds out of the state\u2019s total of 1,489.<\/p>\n

On Friday, the state also surpassed another bleak milestone: 11,003 deaths due to COVID-19<\/p>\n

\u201cI am desperately worried about the hospital situation, even if 35 to 40 percent of the COVID cases are incidental,\u201d said Tri-County Health Executive Director Dr. John Douglas, Jr., referring to patients who go to the hospital for other things like a heart attack, stroke or broken bone and get a positive COVID-19 test during routine testing at admission.<\/p>\n

\u201cI mean, you talk to anybody working in a hospital, and these are really tight times,\u201d he said.<\/p>\n

Other crisis standards of care have been activated<\/div>\n

In recent weeks, one big hospital CEO said the system is on the brink of collapse. UCHealth\u2019s chief nursing executive said she expected January to probably be the \u201cscariest point\u201d of the pandemic.<\/p>\n

To cope with the ongoing challenges the system is facing, the state of Colorado in recent weeks activated crisis standards of care for hospital staffing and for emergency medical services \u2014 think ambulance and paramedic crews. But so far they haven\u2019t been issued for hospital care.<\/p>\n

\u201cWe do not plan to activate the crisis standards of care for hospitals and hope that we will not need to,\u201d said Spencer.<\/p>\n

He urged Coloradans to get vaccinated and stay up to date on their COVID-19 vaccine, and that anyone, regardless of vaccination status, who has symptoms should get tested immediately and isolate.<\/p>\n

\u201cIt doesn\u2019t matter what we wanna call it. The number of patients, the number of available beds, the number of healthcare workers, there\u2019s a fundamental, basic math equation that doesn\u2019t work out right now,\u201d said Dr. Anuj Mehta, a pulmonary care physician with Denver Health, who has worked on a team developing crisis standards and language for the state. \u201cAnd the system is cracking under that pressure.\u201d<\/p>\n

Denver Health launched a virtual hospital for home a year ago It was mostly focused on taking care of COVID-19 patients at home who perhaps needed oxygen and ongoing monitoring.<\/p>\n

\u201cWe\u2019ve expanded it,\u201d Mehta said.<\/p>\n

He said the program has improved its capacity, improved the monitoring of patients by nurses and doctors, while keeping people at home. Normally, these are people that \u201cmay come to the emergency department and we continue to care for them, but maybe we now have this alternate care pathway.\u201d<\/p>\n

Who is coming to ERs right now<\/div>\n

Zane reiterated that change at UCHealth involves specifically how to deal with the least sick patients, a category he said makes up perhaps 20 percent of the ambulatory patients coming to emergency departments.<\/p>\n

\u201cIt\u2019s the category of patients that you envision could have gone to urgent care, but happened to come to an emergency department. It\u2019s a category of patients that need an outpatient study, like an ultrasound, and couldn\u2019t get it for a time that was convenient for them,\u201d he said.<\/p>\n

Some come to the emergency department looking to get a test on that same day, but it\u2019s not required on that same day. It\u2019s patients who\u2019ve run out of their medications, but they\u2019re not critical medications. It\u2019s patients with upper respiratory infections that need no intervention.<\/p>\n

The last time he worked a shift in the ED, Zane said, the department was having 20 to 25 patients per hour arrive for care.<\/p>\n

\u201cAnd when five to seven of those patients that present per hour are of low acuity, by being able to discharge them immediately after a medical screening exam and establishing that there\u2019s no emergency medical condition, that can allow us to care for the high acuity patients that otherwise may have had their care impacted,\u201d he said.<\/p>\n

Zane said coronavirus patient volumes in emergency departments, nationally, in Colorado and at UCHealth have increased \u201cprecipitously.\u201d<\/p>\n

Mehta said Denver Health is seeing similar trends, along with another which has taxed the system: Many people have come to emergency departments seeking COVID-19 tests, which have generally been in short supply outside of hospitals.<\/p>\n

\u201cThere\u2019s no capacity for that,\u201d in the emergency department he said, noting the system has added signs urging people to contact their primary care doctor or go to the state\u2019s website.<\/p>\n

The doctor\u2019s group said it was hoping action by the state would help move the state\u2019s hospitals and healthcare staff onto more firm footing.<\/p>\n

\u201cMorale is down. Physicians\u2019 physical and mental health is being challenged,\u201d said Suzanne Hamilton, CO ACEP\u2019s executive director. \u201cThey\u2019re just really looking for some support.\u201d<\/p>\n

To read more stories from Colorado Public Radio, visit www.cpr.org<\/em><\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

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