As hospitalizations continue to climb amid a statewide COVID surge, Gov. Jared Polis is allowing hospitals to continue non-emergency procedures, so long as the facilities have the bed space to provide them.

Polis issued an executive order last week that extended hospitals' ability to continue offering the procedures through at least mid-December. But he required the state Department of Public Health and Environment to release its own order setting parameters that the facilities must meet in order to keep conducting the treatments, which are not only medically necessary but also are important parts of hospitals' financial stability.

Earlier in the pandemic, facilities here and across the country halted those procedures, to preserve protective gear and to keep bed space open. Those restrictions are largely lifted in the summer, as hospitals developed surge plans and the pandemic slowed. But now, as cases surge once again, decisions about whether to conduct the surgeries that aren't medically urgent.

"For now, hospitals are managing their volumes for non-emergent procedures independently, based on their capacity and staffing levels," Cara Welch, spokeswoman for the Colorado Hospital Association, said in an email Friday. "Many are postponing procedures/surgeries that aren't as time sensitive, especially if the patient is likely to need a hospital admission following the surgery/procedure."

Under the public health order, hospitals must have at least 70 percent capacity, plus the ability to treat all incoming patients without transferring them, to conduct any procedure. The types of procedures are placed into three tiers, depending on the severity and medical necessity. Should hospitals exceed 80 percent capacity, only surgeries for cancers, trauma or neurological issues and other emergency are permitted. The hospitals have to maintain a ready supply of protective gear, as well. Though that was an issue early on in the pandemic, facilities say they've been able to stockpile and order sufficient amounts of the equipment.

The order establishes three priorities that facilities should abide by: that they can continue to offer critical and emergency care; that they maintain enough resources, like protective gear, to continue widespread community testing; and that equipment and capacity are still sufficient. 

Capacity is becoming an increasingly pressing problem in Colorado, though officials say the bigger issue is staffing levels. Statewide, 86% of ICU beds are in use, as are 84% of acute-care beds. While only 14% of facilities are projecting an ICU bed shortage within the next week, more than a third say they expect to face staffing shortages over the same time period.

Even if facilities are in good shape in terms of capacity, the health order still require that procedures "should be limited to those which are time sensitive (and) diagnostically important." Facilities should also consider whether delaying the surgery further "would be determinate to (the patient's) health." A surgical review committee at each facility should set and monitor those priorities.

The order also requires that facilities have a surge plan, which are common and, in some places, are already being enacted. Hospitals' capacity to offer the procedures should also be checked every two weeks, per the health department. 

Other requirements include infection control, screening processes and the creation of a plan to halt the procedures once capacity becomes an issue.