The COVID-19 advisory group wants to review crisis standards for hospital care – Community News
Covid-19

The COVID-19 advisory group wants to review crisis standards for hospital care

Members of the group that advises Governor Jared Polis on the COVID-19 pandemic met Thursday to review recommended standards of care for hospital crises, which would inform hospitals about how to make triage decisions if the current surge in hospital admissions continues.

“There are multiple steps you can take to change your standard of care,” Dr. Anuj Mehta, an intensive care pulmonologist at Denver Health who drafted the revised standards, to the governor’s Expert Emergency Epidemic Response Committee. “The last step is triage, and by triage I unfortunately mean assigning certain resources to some patients and other patients who may receive less than standard or may be given more palliative options.”

Right now, the only crisis standards that have been activated in Colorado are related to the shortage of health workers. For these other standards to take effect, the GEERC would need to approve the updated recommendations; Polis should authorize them; and finally Dr. Eric France, Chief Medical Officer at the Colorado Department of Public Health and Environment, they need to activate.

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Still, the advisory group is reviewing standards to better reflect the current surge in hospital admissions, involving significantly more patients not hospitalized with COVID-19. The standards, if activated, would apply to everyone, not just COVID-19 patients.

“We have activated crisis standards for healthcare for staff and may need to activate crisis standards for medical care and hospitals. As experts have advised me, current hospital crisis standards can really be expanded based on our experience,” France said.

For example, while at the beginning of the pandemic hospitals had to make triage decisions based on the availability of ventilators, that supply problem has been solved by building reserves. These updated crisis care standards may focus on other factors that may need to be assessed, such as other types of oxygen delivery devices, renal replacement therapies, or medications that are in short supply.

Mehta explained that the crisis standards of hospital care are likely to revolve around three central considerations: how likely the patient is to survive without considering the resource, how likely the patient is to survive with that resource, and whether the patient has access to alternative levels of care.

It’s a different approach from earlier in the pandemic, when hospitals may have made decisions based on which patients were most likely to die, even if they were given critical care sources.

“What we’re mostly talking about on most of these dilemmas is the other end of the spectrum,” says Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus. “It tries to find those people who will be okay even if they don’t get service they would normally get… These prediction models are almost the opposite. We don’t try to predict mortality. We’re trying to predict whether you’ll be okay if you don’t get this service.”

One criterion that Mehta says should not be baked into crisis standards for hospital care, he told the GEERC, is whether a patient has been vaccinated against COVID-19.

“A lot of people have an instinctive reaction to this idea that people who have chosen not to get vaccinated are putting a strain on the rest of the system,” he said. “Our ethical principle is to save the most lives, not to evaluate social responsibility.”

Other Statewide Measures

This revision and update to crisis standards for hospital care comes as the state attempts to quell a continuing wave of COVID-19 infections and hospitalizations.

Last week, Colorado hospitals activated the highest level of their patient transfer system, making it easier to move patients between facilities. Earlier this week, CDPHE activated crisis standards for health care workers.

In addition, Polis signed an executive order on Thursday giving the green light for anyone over the age of 18 to receive a COVID-19 vaccination booster, which goes beyond current federal recommendations.

“We want to ensure that Coloradans have all the resources to protect themselves from this deadly virus and to reduce the stress for our hospitals and health professionals,” the governor said in a statement.

In a meeting with the GEERC on Wednesday, Polis also shared additional measures that could be implemented to alleviate hospital stress. Those measures include adding 500 additional hospital beds statewide, urging indoor locations to require proof of COVID-19 vaccination or a negative test, encouraging booster shots and scaling up the use of monoclonal antibody treatment. He has not proposed implementing a statewide mask mandate.

“If we see hospital admissions continue to increase, this is the playbook,” said Polis.

As of Nov. 10, more than 1,400 people in Colorado were hospitalized with COVID-19 and 95% of the state’s ICU beds were in use.