Crisis standards of care means that a hospital or a hospital region has run out of some combination of Space, Stuff, and Staff needed to deliver care at the highest expected level to the patients who are showing up for care. This is a very bad thing. Crisis standards of care means people who normally would be treated with a plausible likelihood of recovery won’t be treated with anything and everything that could be both helpful and concordant with their care goals. Crisis standards means triage committees will be looking at their available resources and making very hard decisions as to which patient, of many, who needs that scarce and valuable resource will receive that scarce and valuable resource. That also means they decide who does not receive a scarce, valuable and needed resource.
Idaho public health leaders announced Tuesday that they activated “crisis standards of care” allowing health care rationing for the state’s northern hospitals because there are more coronavirus patients than the institutions can handle. https://t.co/7260W8E8XA
— Catherine Rampell (@crampell) September 7, 2021
Idaho public health leaders announced Tuesday that they activated “crisis standards of care” allowing health care rationing for the state’s northern hospitals because there are more coronavirus patients than the institutions can handle….
The designation includes 10 hospitals and healthcare systems in the Idaho panhandle and in north-central Idaho. The agency said its goal is to extend care to as many patients as possible and to save as many lives as possible.
The move allows hospitals to allot scarce resources like intensive care unit rooms to patients most likely to survive and make other dramatic changes to the way they treat patients. Other patients will still receive care…
This is being driven by large demand for high end care for COVID patients. But it does not effect just people with COVID. Someone who is in a car accident is being placed into the same decision process to see if they get the last available ICU bed.
Normally when regions are beginning to get close to invoking crisis standards of care there are responses. The first response is to pull in the floating reserve of trained staff via travelling contract nurses and physicians. New York City relied on travelling nurses in April 2020 to give their hospital systems a chance to function while the deployment of the hospital ships also added both staff and space to the hospital system there and in Southern California. Other states have relied on the National Guard to set up and staff field hospitals. Less obvious, but quite common, hospitals will divert patients from high demand and low available capacity regions to regions with beds and capacity. Sometimes these diversions are across town. Sometimes these diversions are across time zones. Hospitals and hospital regions can increase capacity by reducing or eliminating deferrable activities as well. However, when all of these steps are taken and there is still a crunch, quality of care goes down and mortality goes up.
So what can we do?
We can keep on getting vaccinated, masking up and holding physical distance so as to decrease future demand for beds.
We can keep get surveillance testing to pick up the asymptomatic cases that are the source of many chains of transmission.
We can call Congress and tell them to take national policy action.
But until the number of cases crests and then falls rapidly for several weeks, crisis standards of care are either in action or at least on top of mind of hospital administrators in many areas of the country.