Colorado hospitals, primarily those in the Front Range, had to divert patients away from their emergency rooms more frequently in October than they did in the first eight months of 2021 combined, state data shows.
Hospitals switching to divert status, where patients are directed to other facilities with more space, is not unique or inherently worrisome, industry officials said. But the extent to which divert has been used in recent weeks, often spanning several facilities at once, is unprecedented, even 20 months into the pandemic. In mid-October, 13 facilities in Denver were on divert at the same time one afternoon, and that same month, hospitals were directing patients away at nearly 10 times the frequency they had averaged between January and August.
The state's hospitals were on divert status for a combined 4,198 hours in October, a month in which the capacity situation facing hospitals began to spiral toward a crisis point, eclipsed them all. For the first eight months of the year, hospitals spent roughly 430 hours on average each month re-directing patients under that status.
"We certainly saw some waves or times of year when we would see a few more diverts or use of divert more often," said Cara Welch, spokeswoman for the Colorado Hospital Association. "But certainly not like the level we've been seeing this fall."
"It is unprecedented to have all of our emergency departments in our metro area on divert at the same time," added Connie Price, the chief medical officer for Denver Health. She noted the October day when 13 facilities all diverted at once and that it likely wasn't the only day that happened. "We did not even see that in earlier waves of COVID."
When a hospital's emergency department is full, it sends a message to emergency service providers and directs them to send ambulances to another facility. A hospital in an area could switch to divert as often as once a week, Welch said, typically for brief flashes of time. Hospital capacity is generally fluid: A sudden jump in discharges can clear up beds and end divert; a mass casualty event can swallow up a hospital's emergency capacity; or a power outage can force a facility's hand.
But now, Colorado's hospital capacity - from intensive care units and standard medical beds to emergency departments - is quickly approaching its limit. When the intensive care or medical unit is full, it can create a backup that trickles down into the ER and spills out to other facilities. There were fewer than 700 hospital beds available statewide as of Thursday afternoon, the result of burnout-driven staffing shortages, a continued spike in COVID-19 infections and hospitalizations, and increased numbers of patients experiencing with trauma or more standard medical issues.
"When those beds get full, and there are patients in the ED waiting to be admitted, that’s where these back-up situations play out," said Glen Mays, the chair of the Colorado School of Public Health's Department of Health Systems, Management & Policy. ED is shorthand for emergency department. "For many cases, the ED is the entryway in the hospital, but the back-ups can originate and often do originate with inpatient beds. It’s not being able to admit patients: You’re waiting for beds to free up on a general medical floor or in the ICU or a critical care, a more specialized unit."
With the amount of facilities switching to diversion in short order, he said, "it can certainly lengthen transport times and in unfortunate cases can cause delays in treatment."
Paradoxically, Price said, when all hospitals in an area are diverting at once, "none of us are on divert."
"What happens when 13 hospitals are on divert at the same time - the patient's gotta go somewhere," she said. "The patient will be taken somewhere. But it's an uncomfortable position for health-care workers who are taking care of so many other patients, and when that patient is in need of immediate medical care, it’s an uncomfortable position to be in."
Denver Health, which Price said has been at or over capacity for "many weeks," has "boarded" patients in the emergency room until beds are available; health experts have said that's happening elsewhere in the state, as well.
To alleviate the situation, Denver Health has requested additional staffing from the state, and it's started deferring elective procedures "quite aggressively," Price said.
She and Welch both said more members of the public getting vaccinated - or, for those eligible, getting boosters - will help alleviate a major stressor on hospitals. Opening up beds in long-term care facilities, a piece of Gov. Jared Polis's plan to expand bed capacity statewide, should also help in discharging patients who qualify for that level of care.
More broadly, though, Mays said the overall crisis facing hospitals should prompt a re-examination of the health system's infrastructure.
"There is probably a need at the policy level (to discuss) what level of excess capacity we need to build into the system for these kinds of surges," he said. "We spent so much time over the past several decades trying to control the cost of care and reduce excess capacity in these facilities as a cost-saving measure. We were able to do that for a long time without seeing adverse consequences. Now we see the adverse consequences."
