Oregon announces long-awaited crisis care standards for hospitals as COVID-19 count rises

The Oregon Health Authority has issued new instructions for hospitals in case they need to triage patients and decide who gets urgent and life-saving care in a crisis – and who can’t – when there is not enough critical resources, such as intensive care beds, available.

The state health agency has pledged the guidelines by mid-January as part of the state’s response to the burgeoning omicron variant. State health officials say omicron has the potential to overwhelm a healthcare system struggling with increased demand and a depleted workforce two years after the start of the pandemic.

The new triage tool is based in part on updated standards published by Arizona, Massachusetts and Washington.

It orders hospitals to classify patients by assessing the likelihood of their short-term survival until discharge from the hospital.

In the event of a tie between two patients needing the same resources, the person already treated would continue to receive them, unless their condition worsened.

In relationships between two patients with similar conditions presenting at the same time, the triage tool uses randomization to decide who receives care.

File photo: An interior view of one of the examination rooms at Good Samaritan Hospital in northwest Portland.

Alan Sylvestre / OPB

Hospitals can only invoke crisis care standards and use the triage tool after exhausting other options, such as transferring patients elsewhere in the state and canceling elective procedures.

“We are still hopeful that the scenarios for which this tool would specifically help – we hope we don’t need to go there,” said Dana Hargunani, chief medical officer for the Oregon Health Authority.

Hospitals are required to inform the health authority when they adopt standards of care in a crisis and to publish the information to the public.

Unlike standards adopted by many other states, Oregon’s standards do not prioritize any particular group of people for life-saving care. Other states, for example, give more points to pregnant women, those under 18, healthcare workers or single parents.

Hargunani said the triage tool remains a draft document and the OHA is willing to consider changes in the future, but said it was not appropriate for the agency to prioritize a group without an adequate public process beforehand.

“We really need to hear from health care providers, the people of Oregon, where they would rate and prioritize these items for a future tool,” Hargunani said.

The state has announced that it is recruiting members of a resource allocation advisory committee to review its standards of care in a crisis.

During the Delta Variant Wave this summer, healthcare providers and ethicists warned the OHA that the state was dangerously close to a scenario where hospitals could not care for everyone and called for clearer crisis care guidelines.

The agency had disowned the state’s previous crisis care standards after the Disability Rights Oregon group filed a federal civil rights complaint, alleging that the standards discriminated against the elderly, people with disabilities and people of color.

Previous standards provided that in an emergency, hospitals could categorically exclude certain people from intensive care, such as those with certain stages of cancer or other serious illnesses.

Hargunani said the new tool, although it was developed quickly and without an extensive public process, takes into consideration concerns raised by the disability rights community.

“This tool does not take into consideration things that would be unfair or unfair,” she said. “For example, [it’s] It is really important that these tools and decisions do not take into account the judgment on quality of life, or the ability to survive at five or ten years, or simply the presence of underlying conditions.

Use of the new tool is not mandatory, and hospitals that have developed their own emergency care triage guidelines may use them, provided they comply with the guidelines. state policy, as well as federal civil rights and anti-discrimination laws.

A statewide forecast currently predicts that Oregon’s omicron wave will peak in late January with about 1,600 COVID-19 patients hospitalized. This is more than the highest number during the summer delta wave.

However, hospitals in other places affected earlier by the new variant of the coronavirus have observed that a smaller proportion of omicron patients require intensive care and ventilators compared to those infected with the previous variants.

COVID-19 patients currently occupy 17% of filled intensive care beds statewide. The number of COVID-19 patients in the state’s intensive care units has remained relatively stable over the past month, at around 100.

About Antoine L. Cassell

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