Centura and UCHealth lay out next steps for COVID care as cases dwindle
COLORADO SPRINGS, Colo. (KRDO) - As COVID cases continue to drop across Southern Colorado and the rest of the country, hospital systems are now looking towards the future and how to handle the virus as we inch towards an endemic stage.
As of March 9, Colorado's positivity rate is at 4.14 percent, and 91 percent of Coloradans are now immune to Omicron infection and severe disease. Because of this, the Governor's Office has said those who are fully vaccinated and boosted can live their lives as normal.
As we move tentatively back towards normalcy, there are expectations for healthcare systems to stay prepared while transitioning towards an endemic stage from the governor. These include: establishing hospital readiness standards, surge planning, and normalizing COVID patient care in a traditional medical setting.
KRDO recently discussed these expectations with the two biggest hospital systems in Colorado Springs: Centura Health and UCHealth.
Governor Polis's office and the State Health Department have both said it’s time for us to re-enter normal life if we’re fully vaccinated and boosted. Do you agree that’s the point we’re at, or is this move happening too soon?
Dr. Chris Thomson, Vice President & Group Physician Executive, Centura Health: No, it's not too soon. We finally know that if you've been fully vaccinated, your decrease in risk is in the high 90 percent and that's proven. So if you're fully vaccinated, the recommendation of that roadmap was that you can go back to living normally. If you're not vaccinated or not fully vaccinated, you're a bit less protected so we need to certainly keep that in mind.
Dr. David Steinbruner, Chief Medical Officer, UCHealth southern region: I think we're at that point. Even if there is potentially changes within the virus that come back to affect us, at some point we have to get on with some form of normal operations, bringing in people to get surgeries that have been delayed, making sure people are getting their appointments, making sure that we're taking care of all of the other patients. We can't continue to be on crisis mode. We have to be on 'How do we deal with this on a regular basis now?' So we just have to take this into our normal operations and say we can handle COVID. We know how to do it, even with surges that might come up. We know how to address it, how to protect ourselves, and how to protect our patients.
The state’s roadmap for COVID’s future lays out some expectations for hospitals to ensure we’re ready for a surge if it happens. What are you implementing to establish 'hospital readiness standards?'
Dr. Thomson: I think the most important thing that has been implemented, are some of the lessons that we've learned in terms of coordinating. Certainly at times during the pandemic, during portions of the Delta Wave and even Omicron, ran into a point where our hospitals were saturated. So trying to increase that capacity, not necessarily by building physical hospitals, but ultimately by coordinating and building up the virtual capacity that we have to match patients' acuity or their illness with a specific facility, is where we've really been able to have significant success. Being able to engage our rural facilities and being able to care for whatever the acuity of patients that they can care for, being able to transfer patients and move patients between hospital systems has been incredibly important. And finally, being able to decrease the amount of demand that has been coming into the hospitals for certain conditions that we can decentralize to the ambulatory community. We had patients flooding into the two emergency departments that might have had a close contact or might have just wanted to be COVID-tested or that might have had mild illness that we really need to be able to decentralize into the community much more effectively. Some of those hard-wired processes are going to really benefit us moving forward, regardless of what happens, whether we continue to see the decrease of volumes that we're seeing now, or whether we see another surge, which is certainly possible.
Dr. Steinbruner: Over the course of those two years, we've been adapting and working on surge plans that actually were able to absorb up to maybe 159 patients in our local region. I think a month ago, we had 99 COVID patients, and now we're down to 17 within our local regional hospitals in UCHealth. We've established a plan where we can actually surge into rooms, into doubling up if necessary, figuring out ways that we can cross cover with nursing staff to stretch, to be able to cover that, and making sure the doctors are helping each other out to be able to cover that. We have plans in place that we've actually enacted, not as a test scenario, but in real-life as we dealt with this, and watched what worked and what didn't work. So those plans haven't gone anywhere. Those plans are baked into what we're going to do, and we can adapt those plans for pretty much any virus could come across our doorstep. Because a lot of the same precautions and the same use of resources can be applied to that. In many ways, this has been the world's most intense real-life scenario for practice because we've actually been dealing with it.
How do we normalize COVID patient care in a traditional medical setting?
Dr. Thomson: I think if we continue to have surges that might be difficult. We may have to continue to cohort COVID patients away from other patients because they'll require specific infectious processes, infectious protections, and significant awareness of personal protective equipment. If, however, we ultimately get to a point where we can call it an 'endemic,' we're going to have to learn how to have a flu patient in one bed with a COVID patient next door. Ultimately we'll be able to normalize that care as if we're dealing with one of the other illnesses that we feel comfortable with and that we know is out there, influenza is a great example, and that we know we're going to be dealing with on a seasonal basis moving forward.
Dr. Steinbruner: Understanding this particular virus, and the limits of the risk to the virus, and what it actually poses as a risk to your patients and your staff, is one of the best ways to sort of bake that into regular operations. So, understanding how much PPE to use and when. Understanding when to test, and when you don't have to test. Understanding how to cohort people. This is all part of the operation. So in many ways, if you're dealing with Tuberculosis, for instance, which can be something that we have to put somebody on aerosolized precautions and negative pressure room, now we're dealing with COVID and we know how we can isolate people, but not necessarily have to put on those precautions. Baking it in is part of the process right now, where we don't have to make major changes to structural facilities. We don't have to make major changes to staffing, we just know how work that into our usual operations, even while we're dealing with a heart attack or a stroke or a trauma that's coming at the same time.
How are you investing in health care workforce stabilization and expansion?
Dr. Thomson: We definitely understand that this has been an incredibly challenging time for our health care system and for the most important resource we have, which is our people. Many have left the field saying, 'The volume of care, the hours, the feeling of risk and exposure was too much at times.' Moving forward, many of the things that we've mentioned are ideally going to decrease that burden. So if we're able to decrease the burden, and it wasn't the COVID itself, it was really the volume of COVID, and other challenges like supply chain challenges, personal protective equipment shortages, that were really affecting our people the most. If we ultimately get to a point where we can decentralize some of that early care with testing, assessment, immunizations, vaccinations, monoclonal antibody therapy, and other therapeutics, in the decentralized ambulatory community and our normal health care system outside of the hospital, I think we can really decrease the burden on the caregivers inside the hospital. Next, there has been a significant shift. Ultimately, the shift in what's happened with supply and demand of nurses, respiratory therapists, and all of our other supportive colleagues and caregivers. There's been a change in that marketplace Across the country it's been recognized that investing from a remuneration standpoint in our most trusted caregivers and particularly the frontline caregivers that we have, that's been a changed environment. So that has already happened. But mostly, moving forward we need to just make people feel safe, make sure they have all the resources that they have. And again, even though they're taking care of a serious illness, make sure that they're not taking care of an overwhelming burden or number of patients with a serious illness.
Dr. Steinbruner: We actually recognize that one of the most important things that we can do is figure out a way to keep people within health care, to develop our own workforce with those people UCHealth, we want to continue and grow their education. We have something called the Ascend program, which for UCHealth employees, allows us actually to get 100 percent tuition reimbursement and pay for people to get further education either in the field that they're interested in, where they're working now, or maybe switch over. If somebody in transport services right now says, 'You know what, I want to become a medical assistant, I want to do something in the phlebotomy space, in the lab,' they can do that. We can actually help them transition so they don't have to leave our organization, they can actually stay within the organization. That's something that we're really proud of because I think the Ascend program long-term is going to create resiliency within the organization, and really make people loyal to UCHealth to stay on and become the great caregivers that we need bedside to take care of you and your family.
Should we feel confident that the hospital systems in our area are ready for this next phase of COVID?
Dr. Thomson: I do think we should anticipate that people are going to continue to get sick from COVID, we're going to continue to see hospitalizations, and we will continue to see deaths. It is an illness that regardless of whether we can say it is now endemic, or whether we see other surges that we associate with the pandemic, those things will happen moving forward. I think patients and citizens in their community can feel very, very comfortable that we are in a much better place than we were at any other time during the pandemic. This pause has given us a chance to bolster up supply chain, bolster up stores of personal protective equipment, and continue to enhance and solidify the relationships that were built under perhaps even some duress during COVID, during the peaks, during surges. Now we can begin to hardwire some of those processes so that we can enhance our capacity, even if not from building physical beds, from being able to again match patients' acuity and their needs to specific places like hospital beds, or ideally places in our community where they can receive care.
Dr. Steinbruner: 100 percent, yes. I mean, you can't say, you're be prepared for anything... a comet coming out of the sky and destroying the planet would be something nobody's prepared for, alright? But the ability to adapt to these surges, even when we thought we were through it before, and still be able to take care of patients and do it safely, I think it's shown that we're really ready for whatever comes next.
