A rare collaboration among hospital systems during the first wave of the COVID-19 pandemic almost certainly saved lives in Colorado, according to new data that the hospitals released on Tuesday.
Soon after the first known case of COVID-19 emerged in Colorado on March 5, doctors with Colorado’s largest health systems started meeting daily. They shared updates on the new virus that was sickening people in the U.S. and around the world, along with insights on how best to care for patients.
In all, the hospital systems cared for 96% of patients hospitalized with COVID-19 in Colorado. This included 4,903 people, nearly one-third of whom received care at UCHealth hospitals.
The collaboration also included Banner Health, Boulder Community Health, Centura Health, Denver Health, HealthOne and SCL Health.
These health systems dedicated resources to collecting and sharing data and now are sharing the information with both the State of Colorado and the public.
“I have never seen health systems come together like this to serve the state,” said Scott Bookman, incident commander for the State of Colorado’s COVID-19 response team. “This group is to be commended in the way that they have come together to serve all of Colorado.”
Across all the systems, nearly 66% of hospitalized patients were able to go home after their treatments. About 18% were discharged to a different facility, including nursing homes, long term care and hospice care. Of patients hospitalized in the seven systems, 14 percent did not survive COVID-19.
Dr. J.P. Valin, chief clinical officer for SCL Health and one of the leaders of the collaborative, said Colorado is unique in having so many disparate health systems work together. Valin also said no other state has released such comprehensive data about COVID-19.
“This summary of the first wave shows that length of stay, mortality rates and ventilator use were higher in older age groups. Older patients had higher mortality rates and (longer) lengths of stay. Ventilator use decreased from March to May. That could be related to better therapies including antivirals and convalescent plasma,” Valin said.
While the deaths were all tragic, survival rates improved over time as doctors learned how to better care for people sick with COVID-19. Among patients who had to be hospitalized in March, 15% died compared to 10.5% by May.
“Clearly there was a change in how we were able to care for the patients, and there was a change in their outcomes, said Dr. William Neff, chief medical officer for UCHealth, and a member of the collaborative.
“Early on, there was a lot we didn’t know,” Neff said. “The change in results is probably driven more by our education and learning how to better care for patients.”
Younger patients fared the best, while people ages 60 and older who became sick with COVID-19 had the highest mortality rates.
More younger people now appear to be getting sick with COVID-19. Neff and other health leaders believe that’s because older people know they are at higher risk for faring poorly with COVID-19. Thus, more older adults appear to be staying home as much as possible, while many younger people are venturing out now.
As a result of the collaboration among the diverse hospital systems, doctors and health leaders learned critical lessons that improved care for patients. Among the group’s findings:
- Patients who did not have to go on ventilators fared better.
- Doctors learned over time that they could allow patients’ oxygen levels to dip lower than usual in order to keep them from needing to be intubated or placed on a ventilator.
- Turning patients on their sides or stomachs or “proning” them helped both patients who did not need to be intubated as well as those who were on ventilators.
- Patients who were ages 50 to 59 required ventilators at higher rate than any other age group.
- Care for patients with COVID-19 improved over time as providers learned how to care for them better. Fewer patients needed to go on ventilators in May than in March. The length of time on a ventilator also declined from 14 days in March to nearly 12 days in May.
- Patients ages 60 and older had the hardest time coping with COVID-19 and had more difficulty surviving time on a ventilator. Among patients over 60 who needed a ventilator to breathe for them, the mortality rate was between 40 and 48%.
The health systems’ chief medical officers say this information, including the length of stay and ventilatory use data, will help hospitals plan for potential future waves of COVID-19.
Click here to learn more about the new collaborative and their research findings.