Crisis in health care means choosing patients

Hospitals are expected to deliver minimum standards of care to be accredited and eligible to bill Medicare. These standards of care are based on scientific evidence that is important for delivering safe and high-quality care.

Idaho and Alaska recently activated Crisis Standards of Care for their hospitals to follow. These are guidelines for hospitals to follow when they cannot deliver services and provide minimum standards of care. This means they must ration care, which is a rare occurrence in our country. When people in our country need emergency services and other care in our hospitals, they are used to getting it.

Currently, there is a surge of mainly unvaccinated people who have serious COVID19 disease needing emergency and high level of hospital care. There are areas in our country where there are hospitals that do not have enough hospital beds, hospital staff, and enough supplies to provide a high level of care and meet the minimum standards. Idaho is one of those areas. Therefore, Crisis Standards of Care have been activated in Idaho. During Crisis Standards of Care, care may also need to be delivered in unusual ways. For example, conference rooms, tents, garages may be turned into places where patients receive care. Persons who need to be admitted to the hospital may need to wait until a hospital bed becomes available. Sometimes this wait can be for days. The equipment and/or personnel that are needed to deliver standards of care are not available because the demand has outstripped the supply.

If the situation worsens the rationing of care may become more severe. This means that physicians may need to decide which patients are most likely to survive their illness or injuries and thus be the ones to receive limited resources such as oxygen, ventilators, critical care nursing, and medications. For example, a person who suffers a cardiac arrest out of the hospital statistically has a small chance of survival especially if that person is brought to the emergency department with ongoing CPR. Physicians usually continue the CPR and give drugs and other treatments to try to restore life. These efforts can utilize many personnel, supplies, equipment, and take time. However, under Critical Standards of Care, such resuscitative measures may be limited, if performed at all. The necessary resources will be provided to other patients more likely to survive. This is very different from how care is usually delivered in our hospitals.

Critical Standards of Care also apply to the resources that are needed to perform many surgeries and other treatments. For example, patients who need non-urgent heart surgery may need to wait for their surgery until the crisis resolves. Some cancer patients may need to wait for their treatments until the crisis is over. In other words, elective or scheduled procedures and surgeries will be postponed until the needed personnel, supplies, equipment, and medications are not being used up by sicker patients.

Patients are being sent from hospitals in Idaho to hospitals in Washington, Montana, and Oregon that can provide high levels of care. These hospitals also have limited resources because of the surge of unvaccinated COVID19 patients but have more available resources than what is currently available in Idaho. Washington, Montana, and Oregon have not activated Critical Standards of Care, but they are at risk of needing to do so.

Please do your part to decrease the burden on our hospitals by getting vaccinated if you are not already. You may not only be protecting yourself from COVID19, but you may be helping to save another’s life who needs hospital care.