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Understanding When Crisis Standards of Care Are Needed

Hospital systems throughout our region, including those in neighboring states, are being stretched thin by the recent surge of COVID-19 activity.

Both Idaho and Alaska public health officials recently implemented “crisis standards of care” in response to their states’ growing number of COVID-19 patients in need of hospitalization. Many of you have asked about what factors in such a decision, whether a similar action might be needed here, and how we are preparing for such a possibility.

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 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 to providing the greatest good for the greatest number.

Within UW Medicine, we are actively implementing contingency measures to prevent reaching crisis standards of care, including re-scheduling some non-urgent procedures and surgeries, modifying and adapting staffing patterns and assignments and adjusting some policies to allow for more efficient use of our staff, space and supplies. These changes from our usual practice certainly invoke a sense of crisis, yet by altering practice patterns we remain able to provide care to all who need it.

Importantly, institutions within our region and state are working together in order to avoid reaching the point of crisis standards of care. Key to managing hospital capacity across the state throughout this event is the Washington Medical Coordination Center (WMCC) based at Harborview Medical Center. The WMCC is designed to assist with patient placement, reducing the strain on any single healthcare system by directing and transporting patients to hospitals with sufficient capacity. By endorsing and supporting the WMCC and a statewide load-leveling strategy, Washington state aims to avoid having individual hospitals or systems reach a point of crisis standards of care.

Any decision to activate crisis standards of care in Washington would be made by state health officers with input from regional hospital systems and the Northwest Healthcare Response Network; factoring in that decision would be critical metrics such as statewide hospital capacities and staffing ratios, among other things. No one hospital or healthcare system can activate crisis standards of care on their own.

UW Medicine is prepared for this possibility even as we work diligently to prevent it. We have teams of clinicians, nurses and doctors who have been trained on how crisis standards of care are to be applied throughout our state and health system. These teams would be ready to immediately facilitate that transition should it become necessary.

Again, we do not believe this activation to be imminent, and we are optimistic that through continued support from the WMCC, increased vaccination and renewed masking mandates, this current COVID-19 surge can be curtailed. Additional contingency plans can also be implemented should patient numbers increase. It is always good to be looking ahead, however, and planning for all possible outcomes.

We know the past several weeks have strained many parts of our health system and that many of you have put in long hours on the frontlines. While we have not reached a point of crisis standards of care, the challenges of providing outstanding care in the midst of this public-health crisis can be emotionally, psychologically and physically exhausting. We are grateful for your dedication and devotion to our patients and to each other. Thank you for all you continue to do for UW Medicine and our community.

Sincerely,

Lisa Brandenburg 
President
UW Medicine Hospitals & Clinics

Timothy H. Dellit, MD 
Chief Medical Officer, UW Medicine
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

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