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Updated crisis standards of care for patients discussed by Colorado health leaders

Colorado activated the portion of its crisis standards of care plan that deals with staffing health care systems on Tuesday.

DENVER — During a meeting of the Governor's Expert Emergency Epidemic Response Committee (GEEERC) on Thursday, Colorado health leaders reviewed a draft by Denver Health Pulmonologist Dr. Anuj Mehta to update the crisis standards of care (CSC) for patients. It could be activated if current COVID-19 trends continue.

Members of GEERC and invited guests will provide their input on the draft document before a final draft is considered for approval, which could then go into effect if authorized by Gov. Jared Polis (D-Colo.) and activated by CDPHE.

The draft titled "Crisis Standards of Care for Hospital-based Triage" begins by stating that the current COVID-19 surge could lead to many other factors being triaged including emergency department and hospital capacity, dialysis, medication, oxygen delivery systems as well as staffing shortages.

Mehta said the goal of the updated document, when finalized, is to provide a standard guideline health care providers can follow without mandating any specific courses of action. Ideally, Mehta said triage teams that don't have direct clinical access to patients should be making decisions regarding their care.

> Video above: Polis to implement next steps as state hospital bed capacity hits all-time low.

The current draft emphasizes predicting short- and near-term outcomes instead of long-term, which can be less accurate and could incorporate greater bias, Mehta said.

Among issues discussed from when the CSC was updated in March 2020 when the pandemic began was the identification of patients that would likely die regardless of medical intervention. Leaders discussed changing the focus to identifying patients that would be alright if they did not receive certain services.

A focus of the draft is establishing a standard for which patients could not be admitted or discharged earlier than they would in a non-crisis setting, knowing that they are safe enough to continue through outpatient treatment. Along those lines, Mehta said an important aspect of the draft is improving outpatient follow-up.

Overall, identifiers such as socio-economic status, insurance status, race, ethnicity, age and other factors were discussed as being factors that should not be considered.

There was discussion about whether socio-economic status should be considered, specifically when considering if someone has access to an appropriate level of outpatient care.

One example given was a person experiencing homeless who contracts pneumonia would not have access to proper outpatient care and would likely see their condition worsen if discharged too early or not admitted. By contrast, someone who does have the ability to access outpatient care from their home could be considered for an earlier discharge if their condition allows it.

RELATED: Colorado activates crisis standards of care for health-care staffing

Colorado activated the portion of its CSC plan on Tuesday that deals with staffing health-care systems.

The move allows hospitals to prioritize staff for emergencies and reduce the level of care provided for non-emergencies. 

The state said these standards do not impact anyone's access to acute emergency treatment, and they continue to encourage anyone who needs it to seek medical care. 

Individual health-care systems must notify the Colorado Department of Public Health and Environment (CDPHE) when they activate and deactivate crisis standards of care for staffing.

As of Tuesday, nearly 40% of facilities expected staffing shortages within the next week.

RELATED: Polis signs executive order declaring Colorado a 'high risk' for COVID-19 exposure or transmission

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