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Colorado loosening requirements for hospital staff as COVID continues to surge

The Colorado Department of Public Health and Environment authorized so-called crisis standards of care in regards to hospital staffing

A sign outside Saint Joseph Hospital in Denver, photographed on Oct. 22, 2019. (John Ingold, The Colorado Sun)
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Colorado health officials announced Tuesday that they will give hospitals a break from normal staffing requirements and expectations, part of an effort to help hospitals better handle the personnel shortages they face as coronavirus infections continue to surge across the state.

By authorizing so-called “crisis standards of care” related to staffing, the Colorado Department of Public Health and Environment is giving hospitals permission to reduce paperwork requirements for health care workers and to bring in workers to help out in parts of the hospital where they don’t usually work. The standards also authorize hospitals to provide fast-track training to less-experienced health care workers and to potentially bring in patient family members or volunteers “to provide basic patient hygiene and feeding.”

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Authorizing the crisis standards gives hospitals liability protection in case the staffing changes result in patient care that falls below normal levels.

Dr. Eric France, CDPHE’s chief medical officer, said hospital leaders have in recent days been asking him to authorize the standards as hospitals continue to swell with coronavirus and other patients.

“These are not conventional times for the staff,” France said, “and by activating the crisis standards of care, I’m recognizing the stress our health care providers are under. … I’ve helped to ease their mind a little bit.”

France’s authorization does not mean that all hospitals in the state will automatically switch to crisis standards. But it gives them the green light to enact them if necessary.

He said hospitals, despite being full, are still able to provide adequate care to patients. He said it’s important that people not delay needed medical care because they believe hospitals are full.

“If you need to use the hospital, go to the hospital,” he said.

Dr. Eric France, chief medical officer of the Colorado Department of Health and Environment, makes a point during a news conference about Colorado offering coronavirus vaccinations to children, Thursday, Oct. 28, 2021, in Denver. Colorado is also seeing an increase in overall coronavirus cases, which is putting stress on the state’s hospital systems. (AP Photo/David Zalubowski)

Colorado is in the midst of its second-worst wave of coronavirus infections. Hospitalizations of people with COVID-19 jumped again Monday, to nearly 1,400 patients. According to CDPHE data, 79% of those are unvaccinated.

The state’s intensive care units are about 95% full, with the number of available ICU beds statewide hovering at or below 100.

The wave has hit hospitals especially hard because they were already seeing an influx of patients — due to people resuming their normal pre-pandemic lives and also due to people who delayed receiving health care during the pandemic and are now much sicker. Meanwhile, hospitals have faced staffing shortages, as burnt-out health care workers have left the field or taken better paying jobs elsewhere. Nearly 40% of Colorado’s hospitals say they are expecting to suffer a staffing shortage in the next week, according to CDPHE figures.

“They’re all facing the staffing crises of people who are leaving health care and the difficulty of hiring people,” France said.

Colorado previously authorized staffing crisis standards of care during last winter’s coronavirus surge, the state’s worst.

The state has several different crisis standards of care plans, including for EMS services, behavioral health services and hospice care. But the goal of all of them is the same: to figure out an organized, fair way to “gracefully degrade” the quality of care during times of extraordinary strain on the system.

The best-known — and most feared — crisis standards of care are for hospital services. They allow hospitals to ration care to patients at a time when there are not enough resources to go around, and they provide guidance on which patients should be prioritized.

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France said he has not authorized hospital crisis standards of care. Though several states have resorted to that, Colorado hospitals have not yet had to enact them during the pandemic. But he said an advisory committee will meet later this week to reevaluate the hospital crisis standards of care.

When they were initially drafted, early in the pandemic, the state’s hospital crisis standards of care focused on competition for resources that could only go to one patient at a time, like ventilators. But the past 20 months have revealed a more nuanced picture of the challenges hospitals face, such as whether and how to divide resources across multiple patients.

France mentioned dialysis as an example. When supplies are short, should you give a full course of dialysis treatment to one patient or a partial course to multiple patients?

Once the advisory group has gone over the hospital crisis standards, France said he will decide whether to authorize them.

“My hope,” he said, “is not to have to get to that point.”


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