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COVID-19 Surge Brought on Crisis Standards of Care

Hospitals across the country have been severely impacted by the recent massive surge of COVID-19, resulting in patient admissions beyond bed capacity, cancellation of most non-emergency surgeries, and long waits at overcrowded Emergency Departments. At the same time, we have experienced staffing shortages as many hospital staff members were out sick with the disease. Although hospital COVID cases have now gone down significantly, many hospitals in Maryland went to Crisis Standards of Care. That sounds appropriate but frightening. How did it help hospitals like UM Charles Regional continue to provide health care in the midst of an unprecedented crisis?
During the surge we just experienced, it became impossible to provide all normal medical services for two main reasons: the overwhelming number of seriously ill, hospitalized patients, and the critical number of staff members missing shifts due to their own acute illness.
When such a crisis impacts a hospital, it’s necessary to prioritize our functions based on patients’ essential needs for survival and recovery. Tasks that don’t advance those goals may be done less often or not at all.
What tasks are those? Some may be regulatory documentation requirements that provide review data but don’t add value to the care. A provider may not be able to speak immediately with family members. We have to modify our work processes and pare notes back to essential communication. There’s less time for the personal touches that help make a hospital stay more bearable, and that patients reasonably expect from their health care providers.
Crisis standards mean that many surgical cases are delayed, sometimes for weeks, to keep beds open for seriously ill emergency patients and to redeploy surgical staff for patient care. Hospitals and surgeons prioritize cases so patients with more urgent or rapidly progressive problems can still receive the surgical care they need.
At UM Charles Regional, it involved redeploying staff to fill in critical needs. Under crisis standards at our hospital, physicians performed care outside their normal specialty, such as having anesthesiologists work with Emergency Department or ICU physicians for airway and respiratory procedures. Administrative and ancillary staff worked heroically in our patient care units to take the place of support staff who were out sick.
Please take a moment to reflect on that. Employees from every part of this community hospital stepped outside their normal responsibilities, often on a volunteer basis, to help provide care and support for patients when our community needed the most care.
An obvious question is how much the quality of care may suffer under crisis standards. Patient safety aspects are maintained by reducing non-emergency care and focusing remaining staff on essential functions. However, there is high demand on fewer staff who are fatigued and have less time per patient. How do hospitals compensate for these difficulties?
The answer is by focusing on the fundamentals of patient experience at a hospital. These include:
Standardized patient safety procedures: Hospital care is complex. People sick enough to be hospitalized usually have multiple serious medical conditions and everyone’s different. There can’t be a single care plan for everyone. But there are pathways for specific diagnoses that can be followed while addressing other problems. There are standardized practices for patient identification, universal precautions, safe medication management, and other processes. These help to avoid errors even when we are short-staffed and under stressful conditions.
Teamwork: As mentioned, hospital staff who don’t work in clinical care areas pitched in to keep supplies stocked, beds and surfaces clean, vulnerable patients safe, and dozens of other functions so that clinical staff could focus on patient care.
Provider and staff competence: To err is human, and system-based safety practices are aimed at helping staff carry out their roles safely and without error. But all of them have been trained to take personal responsibility and perform their functions competently and safely as well. We recruit them for their skills and professionalism, and depend on them when all systems are under strain. The term “healthcare heroes” is not an exaggeration.
Crisis conditions like the recent COVID surge are extremely rare. We’re not out of the woods yet, but hospitals like this one and our patients have withstood terrible conditions and are emerging intact. That’s a testament to the character of the people who work at your community hospital, and I hope you’re as proud of them as I am to be on this team.
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