California hospitals should prepare for crisis care, hospital association CEO says

There is a very real possibility some hospitals in California may need to resort to crisis care over the coming days to weeks as COVID-19 hospitalizations continue to swell in the state, according to Carmela Coyle, president and CEO of the California Hospital Association.

About 40,000 Californians are testing positive for COVID-19 daily, and about 12 percent of patients require hospital care. This means the state is recording 4,000 to 5,000 more hospitalizations each day, Ms. Coyle said during a Jan. 13 media call.

As of Jan. 13, the state reported 22,500 COVID-19 hospitalizations — more than four times the volume seen during this summer's surge. 

"Numbers that describe the surge are such that it is something we all need to think about and prepare for," Ms. Coyle said. "Many of us are very concerned. The circumstance in the southern part of the state is quite dire. This weekend and over the next two weeks, we are on the cusp of what we think may be another peak of that surge."

So far, no California hospital has declared the need for crisis care. Nationwide, some hospitals have issued this declaration but received additional resources and support before they had to act on it, according to Christopher Meyers, PhD, a medical expert on crisis care and and director emeritus of the Kegley Institute of Ethics at California State University, Bakersfield.

"This is unique because if we have to take that turn, it will be for an extended period of time across multiple facilities, if not broad regions or the state," he said. 

Under California guidelines, hospitals or counties may declare the need for crisis care if leadership determines the organization can no longer provide the maximum level of care due to scarce resources and high demand. 

The state's crisis care framework transfers clinical decision-making processes from the treating physician, patient and family to a triage team of various leaders and medical experts. The triage team uses objective criteria and a scoring model to identify patients who are most likely to survive or benefit from treatment. The triage team's decision is then communicated back to the treating physician and family, who have the opportunity to appeal the decision. 

"There are immediate benefits in that the treating physicians won't have to make the hard decision and tell the family that we don't have the ventilator, bed space, etc., to meet a patient's needs. That burden is put on the triage team," Dr. Meyers said.

Patients who are deemed ineligible from receiving lifesaving treatment would be switched to palliative care services to ensure they get the best possible treatments, given the constraints.

Ms. Coyle said hospitals are working closely with state and county officials to try to prevent healthcare facilities from needing to resort to crisis care. 

"At this stage, the only way to avoid it is to reduce demand," Dr. Myers said. "It's up to the public to engage in safe COVID-19 practices and make it such that we never have to put these policies into effect."


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