With Colorado hospitals full and short-staffed, some health care providers may need to work in roles they aren’t certified for

Hart Van Denburg/CPR News
Fresh blankets for a patient in the COVID-19 intensive care unit at Rose Medical Center, Denver, Nov. 13, 2020.

Updated at 5:04 p.m. on November 9, 2021

The state of Colorado activated a key emergency measure Tuesday to cope with rising COVID-19 hospitalizations. Chief Medical Officer Dr. Eric France initiated the Crisis Standards of Care for staffing.

It gives hospitals greater leeway to deal with staff shortages, illness, workload and burnout. It allows for workers to be moved to care for a sicker level of patient than they normally would and gives hospitals and doctors emergency protection from liability.

“This is really for health facilities and hospitals that focuses on the issues they face with staffing during a time of crisis,” said France.

He said due to the pandemic, there is a “limited, flexible” ceiling of how much work providers can do before hospitals and their staff have to change their practices. That includes to “maybe increase the ratios of nurses to cases, have people step up into new roles.”

France said the move aims to ease the pressure and grind on providers.

“It can be a very stressful time for the workforce themselves. We all know that they're experiencing some staffing shortages right now, and that makes everyone have to work harder,” he said.

The change should bring comfort to, say, a respiratory therapist, nurse or a doctor, that they wouldn’t get in trouble if they hadn’t yet updated their accreditation or training.

“The crisis crisis standards of care for staffing is trying to provide relief so that these staff can do what we need them to do, which is focus on patient care,” France said.

The move continues the state’s strategy of having hospitals shoulder the burden rather than implementing measures like mask mandates or restrictions on gatherings, tools that were more broadly used earlier in the pandemic.

The emergency measure does not mean rationing of care

France stressed the move does not mean a rationing of care. The state last activated these protocols during last fall's surge and deactivated them in February.

“This doesn't mean that the hospitals are moving into a time of rationing care,” he said. “That’s not what this is about at all. It's not about sending a message to discourage people from using the hospitals.” 

But the move could inconvenience even the state’s vaccinated population.

“I think it's actually a kick in the pants for even people who are vaccinated, that even routine health care things may get delayed and everybody will be impacted when they go to the hospital,” said Dr. Anuj Mehta, a pulmonary and critical care physician with Denver Health and advisor to the Governor's Expert Emergency Epidemic Response Committee.

“This isn't just something that's happening for patients that have COVID when they go to the hospital, this is happening for everybody,” Mehta said. 

And hospital patients who have been admitted or are waiting to may also experience delays in care. 

“You may wait a lot longer for a nurse to come see you when you’re in the emergency room or on the hospital floor...one nurse may be taking care of a lot more patients,” he said. “So your care may be slower and may get delayed. There's also the possibility that outpatient providers may be asked to start working in the hospital. And if that happens, then you may be waiting a lot longer for outpatient care.” 

“It's an important step to alleviate the terrible strain that is happening on healthcare workers around the state,” said Mehta, who fears the current spike in cases could lead the state to activate the full Crisis Standards of Care, essentially a rationing of care.

“It's a message to the state that we're taking this seriously because our healthcare workforce is burned out. Everyone is working really hard, taking care of hospitalized COVID patients, Dr. Lily Cervantes, an associate professor in the department of medicine, at the University of Colorado School of Medicine, who also cares for patients as a hospitalist at Denver Health. 

She stressed Coloradans could help by getting vaccinated, if they aren’t already. “We all know that the majority of these hospitalized COVID patients are unvaccinated. And so protecting ourselves, protecting others through vaccination and mask use is critically important.” 

COVID hospitalizations have doubled since the end of August

Colorado's latest coronavirus surge is showing no signs of relenting. COVID-19 hospitalizations leapt above 1400 patients Tuesday, as cases also continued to rise. That figure increased by 32 patients from Monday to 1,426.

That was up nearly 100 since Friday, and yet another high for this surge, which is hitting levels seen since last December.  This latest wave hasn’t yet reached the 1,847 hospitalizations recorded December 1, 2020, but the climb has been steep. In the roughly 10 weeks since the end of August, COVID-19 hospitalizations have doubled. They’re up five fold since mid-summer. 

As of Monday, the state had just 123 intensive care beds available and 93 percent of ICU beds were in use; nearly a third of Colorado hospitals anticipated an ICU bed shortage within the next week.  

Driving the problem is a shortage of staff, which has become a chronic challenge with many frontline health providers feeling burned out and many others leaving the field. In the next week, 38 percent of hospitals anticipate a staffing shortage.

Other metrics look just as grim. Around 25 Coloradans were dying each day as of the start of this month and the state could surpass a pandemic death toll of ten thousand deaths in the coming months. 

Transmission levels remain high. The state's seven-day positivity rate is now 9.49 percent, well above the desired 5 percent level.