As Colorado hospitals prepare for a possible surge of patients infected with the new coronavirus, they are planning to shuffle doctors and nurses who normally practice in such specialties as obstetrics, family medicine and gynecology into the emergency department to keep up with the need.
COVID-19 IN COLORADO
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Centura Health put a call out to all of its doctors to take inventory of who may have the qualifications to help. UCHealth is making sure physicians who don’t normally handle inpatient care are brought up to speed with best treatment practices for the new coronavirus. And Gov. Jared Polis is calling on retired medical providers to return to hospitals and reinforce the front lines.
“This is probably going to be an all-hands-on-deck scenario,” said Dr. Shauna Gulley, chief clinical officer for Centura Health who also is part of the massive hospital system’s incident command for coronavirus.
And Gulley has good reason to believe normal staffing may not be enough.
In Italy, one of the countries hit hardest by the coronavirus, hospitals have had to bring in doctors from all specialty areas to care for critically ill patients. “We had to teach cardiologists, dermatologists, rheumatologists — specialists of something very different from respiratory failure — how to treat this patient,” Dr. Fabiano Di Marco, head of the respiratory unit in a northern Italy hospital, told The New York Times.
Hospitals across the U.S. are preparing doctors who don’t normally care for the seriously or critically ill to respond to COVID-19, the disease caused by the new coronavirus, in a massive, hasty realignment of the American health care system as it tries to keep up with the pandemic. All elective and nonessential surgeries and other medical procedures in Colorado have been banned by the governor until at least April 14 in an effort to preserve supplies and manpower.
While pulmonologists — respiratory experts — and emergency room physicians may normally care for patients who need admission to a hospital for respiratory distress, there simply aren’t enough of them to handle the number that may come in the next few weeks. There is hope that extreme social distancing measures being put into place might help avoid calamity — “we continue to knock on wood,” said one doctor who leads a Colorado Springs hospital — but Colorado hospitals say they are getting ready just in case.
There are nearly 1,000 confirmed and presumed coronavirus cases in Colorado, including more than 80 who are hospitalized. Potentially thousands more are infected who haven’t been tested. At least 11 people have been killed by the virus and there are outbreaks in a handful of long-term health care facilities.
Gov. Jared Polis on Sunday painted a bleak picture for Colorado’s health care system if social distancing measures aren’t strictly followed — or if they don’t work.
“If we don’t do more to slow the spread of the virus, our health care system will be overwhelmed and doctors simply won’t be able to treat every patient,” Polis said. “Therefore, we could be forced into a wartime triage situation, having to choose who gets a ventilator and a bed or who doesn’t. Who lives and who doesn’t.”
Hospitals are doing everything they can to ensure the situation doesn’t become dire.
Dr. Jean Kutner, chief medical officer for UCHealth University of Colorado Hospital, said pulmonologists at Children’s Hospital Colorado have offered to help. And they’re pulling together best practices and treatment plans across the entire UCHealth system to make sure physicians are best prepared to handle any coronavirus patient who needs care.
On top of that, the hospital is also bolstering its telemedicine capabilities to be able to screen patients to determine who can recover on their own and who may need further care.
Meanwhile, University of Colorado Hospital is working with Denver-area hospitals — both in its network and not — to make sure that physicians have operating privileges to move around should one facility have a staffing need.
“Some terrific collaboration there,” Kutner said.
Kutner said University of Colorado Hospital is also planning to use doctors who typically operate in other specialities for emergency care if the need arises. Many are already certified in internal medicine and so just have to make the transfer to inpatient care from outpatient.
Doctors who don’t normally work in the emergency room at University of Colorado Hospital and Centura Health’s 15 Colorado hospitals will be used to care for less serious coronavirus cases and for everyday emergency room cases.
“There’s still plenty of patients coming into our hospitals who don’t have COVID-19 and need care,” Kutner said.
Gulley said hospitals and hospital systems have more capacity to handle emergency cases than the public may know.
“Many physicians carry more than one board certification, just by definition of how we are trained,” said Gulley, who is qualified for pediatrics and internal medicine. “People don’t really recognize that. I can’t think of one right now that’s not qualified to handle a COVID-19 patient under some circumstance. Your internists, your family medicine physicians, even your OB-GYNs can care for COVID-19 patients. And we are all expecting to.”
Dr. Bill Plauth, chief medical officer for Penrose-St. Francis Health Services in Colorado Springs, said his hospital will be very thoughtful about who handles the most serious cases.
“Intensivists are certainly the experts we’d look to, but hospitalists, who have internal medicine family practice training and work in the hospital regularly, work in the intensive care unit, including on patients who are on ventilators,” he said.
Hospital systems are also planning to put to work recently retired doctors and nurses whom Polis asked to come back and bolster the number of medical providers who can respond to the crisis. But they likely won’t be put on the front lines.
Gulley points out that many of them may be over 60, which puts them at a higher risk of becoming critically ill or dying from the virus. Centura Health is planning to use them primarily in telemedicine. University of Colorado Hospital said it also will likely direct the returning doctors and nurses to similar work.
Kutner said even medical students are being put to use, organizing volunteers and handling child care and tutoring duties for medical professionals’ children.
But the hope is all of the plans wind up not being needed. Medical professionals are asking for people to do their part in prevention.
“I don’t think we can emphasize that message enough,” Kutner said. “We’ve got to prevent the spread.”
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