Warning that Colorado’s health system is “in jeopardy of being overwhelmed,” state hospitals escalated their joint efforts to transfer patients Wednesday amid an ongoing spike in hospitalizations officials say likely won’t abate before the end of November.

That escalation gives the hospitals involved the ability to move patients around on a statewide basis, rather than regionally or between individual hospitals. It creates “a single point of contact for any hospital in the state that needs to transfer patients due to capacity concerns,” the Colorado Hospital Association wrote in a statement Wednesday. Sicker patients can be sent to more specialized facilities, while recovering Coloradans can be moved to hospitals with more available space. 

The Combined Hospital Transfer Center was launched by the state’s hospitals almost exactly a year ago so patients could be moved between facilities as beds filled and space grew more limited. It was deactivated earlier this year then fired up again in August as cases rose. It’s now been elevated to its highest tier, the hospital association said, because of the “monumental strain” the current COVID-19 surge has placed on the state’s health care system.

But even last year, when COVID-19 hospitalizations ran higher than they do now, the transfer system was never elevated to tier three status, said Cara Welch, the spokeswoman for the hospital hospital association. Under tier one, a large health system would have a smaller, often rural partner. The smaller facility could call its larger partner and ask to move a patient. If the larger hospital couldn’t take him or her, they would ask another large system. 

Now, Welch said, transfer coordinators from every large system will meet twice a day every weekday to facilitate transfer. It’s an “unprecedented” move, she said. 

“This is an extraordinary step taken by the state’s hospitals and health systems,” Darlene Tad-y, the vice president of clinical affairs for the hospital association, said in a statement. “Even when under immense pressure, the state’s health care system continues to work collaboratively with each other and our partners at the state to ensure the best care possible is available to every Coloradan that needs it. However, activating Tier 3 of the (transfer center) should send a clear message to Coloradans: our health care system is in jeopardy of being overwhelmed.”

Hospital and state officials have said a number of things are contributing to the strain on hospitals. COVID-19’s latest surge is playing a prominent role, but so, too, is a lack of staffing across the health care system. The shortage of providers exacerbates capacity issues, officials said: The space may be there, but there aren’t workers to cover it. What’s more, there’s been a spike in more routine care; hospital officials say patients delaying care for the first year of the pandemic has sent many to the hospitals in worse shape than they would have been had they been treated earlier or more regularly. 

Gov. Jared Polis has taken several steps in recent days in an effort to alleviate the strain of hospitals without instituting population-level orders like masking. One of those steps fell last weekend, when the governor issued an executive order centralizing the transfer system and allowing patients to be moved without their prior consent.

He’s also emphasized the use of monoclonal antibody treatments, which have been shown to be effective at blocking hospitalization if given quickly to newly symptomatic patients. The state has also blocked nonessential cosmetic procedures, reactivated its crisis standards of care to help hospitals navigate staffing shortages and requested personnel from the Federal Emergency Management Agency.

State officials have given increasingly grim updates on the pandemic situation in Colorado in recent weeks. State officials said Tuesday that Colorado has the fifth-highest rate of COVID-19 spread in the country; according to the New York Times, it’s rate has grown more in the past two weeks than the other four states in the top five. Hospitalizations have hit their worst stressed moment since the late 2020 surge and have surpassed the first pandemic wave of spring 2020.

What’s more, the situation does not appear likely to abate soon. Polis and Rachel Herlihy, the state’s epidemiologist, said Tuesday that the peak will likely not come until the end of November and that it could match the crisis from a year ago. 

The state has not yet activated the crisis standards of care that would allow hospitals to begin rationing care, if space becomes critically limited. An expert told the Gazette he would be surprised if that happened but that some hospitals were already so stressed that they were keeping intensive care patients in emergency departments. Welch said hospitals still have a number of moves to make before care rationing would need to be implemented. But she said with the current trajectory of hospitalizations, the state was moving toward its worst-case scenarios.

Banner Health, which has a heavy presence in Northern Colorado, has been running over capacity consistently for weeks. The system’s internal projections indicate it may not hit its own peak until Dec. 18.

“The hospitals – we have reached a level of stress in which we need support,” Angela Mills, the chief medical officer for Banner North Colorado Medical Center, told the Gazette last week. “That’s a fact. We need support.”