Washington health department updates standards for rationing care if hospitals get overwhelmed


Washington officials have updated standards hospital officials will use if they get so many patients they no longer have the ability to treat them all.

The state's crisis standards of care, which are used when hospital and health care system resources are overwhelmed, have been sent to health care facilities ahead of what could be another surge in hospitalizations with the spread of omicron.

Hospitals in Washington have committed to surge together, meaning no single hospital or health care system will go into crisis standards of care alone. The Department of Health must declare crisis standards of care statewide, if it becomes necessary.

For now, the Washington Medical Coordination Center, based at Haborview Medical Center in Seattle, is helping to coordinate patient transfers and placing patients when hospitals cannot use their normal transfer patterns.

In mid-October, the department released new guidelines for prioritizing patient care in the event that it must be rationed, particularly in regards to resources like intensive care beds.

Public health and hospital officials hope to avoid going into crisis standards of care in the coming months.

"We need to do everything we can right now to keep the system from tipping into crisis standards," Taya Briley, vice president of the Washington State Hospital Association, told reporters last week.

COVID hospitalizations in Washington appear to be on the rise again, after declining significantly since earlier this fall, when the delta variant led to the largest surge in hospitalizations from the virus to date.

As of Dec. 28, there are 832 COVID patients hospitalized statewide.

Each hospital must designate triage teams, made up of providers and ethicists but not those who are directly caring for patients. These teams will be responsible for evaluating patients' conditions every 24 hours, should the hospital need to ration resources.

The triage team follows a system laid out by the Department of Health, which codes patients based on an individual patient's likelihood of survival and current response to treatment. The triage team makes decisions based on information collected on a health department form. The form contains no identifying information beyond relevant medical history and the patient's age.

When the triage team assigns a patient a priority level, this is what would be used to ration care. So someone with a 90% or higher likelihood of surviving should they be given the resource will get priority over those with lower likelihoods of improving.

The new standards give specific scenarios of patients with or without COVID and how they would be prioritized by triage teams based on their conditions.

Additionally, the new standards spell out a "tiebreaker" process should two patients with the same priority be needing the same resource, which prioritizes a person who already has the resource, is pregnant or has higher social vulnerability based on where they are from. In that case, someone who is likely to have poorer access to quality health care based on where they live would have a higher priority.


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