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Dr. Jaya Kumar is constantly monitoring the flow of patients at Swedish Medical Center. As chief medical officer of the Englewood facility, she attends at least three meetings a day to discuss who can be safely discharged and how to accommodate more incoming patients. Throughout the day, whenever she has a free moment, she also checks an app on her phone that gives her real-time information on how many patients are coming and going.
“Just last night, I was texting with all the members of our C-Suite until 10 p.m. about how many discharges we’ve had and what we can do to make it better,” Kumar told 5280 during a visit to the hospital a few weeks ago. “It is a dynamic process that we are always monitoring.”
That sort of vigilance is an ever-present part of Kumar’s job, even when the state isn’t struggling through the second year of a deadly pandemic. But as facilities continue to deal with a surge in COVID-19 cases caused by the Delta variant, the way hospitals are managing resources and capacity is once again a point of interest. Unlike the first few months of the pandemic, medical centers are now also caring for an influx of trauma victims and people with other illnesses who delayed care in the early days of COVID-19. But while health officials say that concerns about capacity are valid, especially with flu season on the horizon, they also know hospitals have a proven history of managing ballooning patient counts, as well as plans for how to deal with those situations.
“This is a set of circumstances that hospitals have been very skilled and experienced at managing for a really long time,” says Dr. Darlene Tad-y, vice president of clinical affairs for the Colorado Hospital Association. “This is a season, historically, that our health care system and hospitals have had to manage the surge of flu patients coming in. Hospitals have dealt with this before—and they already have efficient processes in place.”
Kumar says that Swedish’s capacity hovered around 80 percent through much of September and early October. The same was true at most of the hospitals in the Denver area run by Swedish’s parent company, HealthOne. “I would say we typically expect to be running at those high percentage capacity numbers from November though March,” Kumar says. “What is unique right now is that it has been more of an extended surge season, starting earlier than in other years.”
The extended surge ahead of flu season is somewhat concerning, according to Kumar, especially because of the potential for burnout among staff. But she also notes that it is not unusual for hospitals to operate near 100 percent, or sometimes as high as 120 percent capacity, for short periods of time during respiratory illness season.
“In 2019, for example, we didn’t have COVID-19, but we did have the flu,” Tad-y says. “Maybe it only happens once a year, or once every other year, that hospitals [go over capacity]. But hospitals know how to efficiently handle these issues, transitioning and opening storage units, getting staffed up, and things like that.”
Swedish, for example, has detailed policies for how to deal with every possible capacity level up to as much as 150 percent. “Each plan is so detailed and intricate,” Kumar says. “But it involves things like, if we go from 70 to 100 percent capacity, we are going to open up five beds outside the ICU as a stepdown unit or backup ICU beds.”
Still, considering hospitals have been slightly strained through the late summer and early fall, flu season could be a tipping point. “Hospitals are designed and function in a way that they should be busy,” says Stephanie Sullivan, assistant vice president for communications at HealthOne. “But as we go into flu season, we don’t want to be operating at 120 percent capacity every day. We do operate above 100 percent capacity for a period of time every year, but we can’t do it for forever.”
At the moment, Sullivan estimates five to seven percent of patients at HealthOne hospitals are sick with COVID-19. Much of the capacity at those locations is dedicated to trauma victims or those suffering from long-term illnesses, such as cancer, that went undiagnosed early in the pandemic. Kumar attributes the lower number of patients suffering from the novel coronavirus, in part, to Colorado’s high vaccination rate. Currently, more than 70 percent of eligible people are fully immunized.
But inoculations aren’t the only thing helping. Both Kumar and Tad-y note that the type of care given to COVID-19 patients has also drastically improved. Treatments, including heated high-flow oxygen, monoclonal antibodies, and proning (turning a patient on their stomach and angling their bed the opposite direction to relieve pressure on the lungs), have limited both the number of people in the hospital and the length of stay. At the start of the pandemic, about 50 percent of COVID-19 patients at Swedish were in the ICU. Now, the number is closer to 20 percent. The amount of time COVID-19 patients spend in the ICU has also gone down about 50 percent since March 2020.
The shorter times in the ICU for COVID-19 patients make it important to monitor overall hospital capacity, instead of just ICU capacity. “In reality, capacity, and our hospitals ability to provide care, is actually very dynamic,” Tad-y says. “It’s like a bus. At every stop, some people are getting off and some people are getting on. So the number of patients a hospital can take care of in a day isn’t limited to the number of physical beds they have, but rather the movement of patients into and out of the hospital.”
Tad-y says that the state has also continued to play a key role in monitoring the situation. “Having resources where we can look at data in real time,” Tad-y says, “and make decisions based on a statewide perspective, and where capacity is across our state, has been incredibly important.”
Despite worry about the upcoming respiratory illness season, that confluence of factors has many health officials optimistic about medical facilities’ ability to manage any issues. “Our hospitals are very well positioned to make sure that Coloradans have the access to care that they need,” Tad-y says. “They make a lot of effort to make sure they have the capacity to care for our community.”