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The tremendous surge in COVID-19 cases, driven by the highly transmissible Omicron variant, is straining health systems statewide, including here at UW Medicine. We recognize how stressful and challenging this is for those of you on the frontlines.

Last September, near the height of the Delta surge, we shared how and when we would implement “crisis standards of care,” which fortunately were not needed. But given the speed at which the situation is changing — and right now it is changing daily, if not hourly — we thought it timely to revisit the topic and provide you with an update on our plan to manage the current surge — and, should it be necessary, a transition to crisis standards of care.

Managing the current surge

Hospital leadership continues to monitor and track key metrics related to capacity and staffing across the system, focusing on key areas that will not only allow us to functionally maintain our standard of care, but also to respond to emerging needs. To that end, we have activated our teams to take the following steps:

  • Reduce administrative burden on nurses to focus more time on patient care: To provide the necessary level of care for each of our patients, we are actively working to reduce the time spent charting.
  • Utilize nurse and care extenders: To provide our nursing and support staff with help in caring for our patients.
  • Provide practitioner support through moonlighting and reduced documentation: Working with faculty, residents and fellows, we are providing additional support for our practitioners through faculty and house staff moonlighting pools and additional teams as needed to support our clinical services. We are also working with our medical directors to reduce rounding and documentation requirements for specific patient populations with low acuity needs.
  • Engage staffing agencies: To meet increased demand, we will continue to partner with staffing agencies and implement an accelerated onboarding procedure for new team members.
  • Expand patient care areas: To maximize our capacity, we are caring for patients in new and different places and designating more space within our hospital for patient care.
  • Postpone non-urgent surgeries: To address staffing shortages and capacity challenges, we are postponing outpatient and inpatient non-urgent surgeries and procedures that are scheduled through Monday, Jan. 31.
  • Shift to telehealth visits: To preserve resources for in-person care, as an organization, we are shifting as much care as possible to telehealth through Monday, Jan. 31.

Preparing for “crisis standards of care”

Crisis standards of care are defined by the National Academy of Medicine “as a substantial change in usual healthcare operations and the level of care it is possible to deliver, which is made necessary by a pervasive (e.g., pandemic influenza) or catastrophic (e.g., earthquake, hurricane) disaster.”

Crisis standards are rarely needed, but once invoked by state health officers trigger more drastic emergency measures such as the explicit rationing of life-saving medical resources, the implementation of new operational policies, and a switch in focus from care of the individual to providing the greatest good for the greatest number.

We are not there yet. We are, however, implementing what the Centers for Disease Control and Prevention (CDC) calls “contingency capacity strategies” to manage our staffing shortages. This is the second of three response levels on the CDC’s continuum for addressing staffing shortages, positioned between “conventional” and “crisis” options; it explains why we are caring for patients in different spaces and managing our staffing to functionally maintain our standard of care, among other things. While neither contingency nor crisis staffing strategies are the same as crisis standards of care, we recognize that our current approach feels different to our clinicians and staff, and we appreciate your efforts to accommodate the changes.

Even as we work to avoid crisis standards of care, it’s important for you to know that UW Medicine is prepared for this possibility. Should Washington state’s healthcare system (WSHA, DOH, the Northwest Healthcare Response Network) deem crisis standards of care necessary, our teams of doctors, nurses, ethicists, and other clinicians, under the leadership of pulmonary and critical care physician Dr. Mark Tonelli (UW Medical Center – Montlake) are prepared to implement crisis standards at a moment’s notice. Should that happen, everybody in the system would have an important role to play in the transition.

We continue to monitor the situation closely and will begin sharing twice-weekly surge reports to keep you apprised of any developments as they happen. Thank you again for your incredible efforts and ability to adapt throughout this pandemic. We will get through this together.



Lisa Brandenburg 
President, UW Medicine Hospitals & Clinics
Vice President for Medical Affairs
University of Washington

Timothy H. Dellit, MD 
Chief Medical Officer, UW Medicine
Vice President for Medical Affairs,
University of Washington and
President, UW Physicians

Cindy Hecker
Chief Executive Officer
UW Medical Center

Sommer Kleweno Walley
Chief Executive Officer
Harborview Medical Center

Jeannine Grinnell
Chief Executive Officer
Valley Medical Center

Debra Gussin
Associate Vice President
Primary Care Services and Population Health
UW Medicine

Jeff Richey
Executive Director
Airlift Northwest
UW Medicine