ER Physician Explains Utah’s ‘Crisis Standards Of Care’ As Hospitals Feel Strain

SALT LAKE CITY, Utah – State health officials said the unchecked growth of Utah’s rate of positive COVID-19 tests has them and doctors very concerned that the state’s hospitals will soon have to enact “Crisis Standards of Care.”

“We’ve said to the people of Utah one of the things we must avoid is the overwhelming of our hospitals and our medical system, and we know that the consequences of that are dire,” Gov. Gary Herbert said. “If we, in fact, allow that to happen, and clearly as we see the numbers today, we’re just far too close to having that occurrence take place. “

Several health care officials joined Gov. Herbert’s weekly coronavirus update to explain what is in the Crisis Standards of Care and what it would mean if leaders are forced to put it into action.

Greg Bell, president and CEO of the Utah Hospital Association said, “The Utah Hospital Association under contract with the state of Utah has prepared crisis standards of care, meaning if medical resources, ICU beds, staff, drugs, supplies become so short that we need to allocate or triage those resources, you want to do that in a fair, humane, ethical way, so that no one is disadvantaged, so that the disabled, the healthy, the old (and) those with underlying conditions are all treated on a similar basis.”

Bell said last week the hospital association warned the governor’s office that Utah is very close to putting those standards into place.

“For years we have worked on how to better provide care even when our capacity is limited and we have doubled down on these efforts over the last seven months,” said Dr. Mark Shah, an emergency physician at Intermountain Healthcare.

He explained that nurses are taking care of more patients than normal, many are working forced overtime and the state has worked to deliver adequate personal protection equipment for caregivers and patients.

“We are actively working with the state and across all systems to actively recruit nurses from not only within our state, retired and semi-retired nurses, but also around the country. And we have had success with that,” Shah said. “But we still can’t fill all of the needs. We’ve worked closely with the division of public licensing on waivers, the state is working hard to encourage all of you to get a flu vaccine.”

Other measures include load balancing, which shifts patients across health systems and having health care workers move into additional roles with supervision. All of this, Shah said, to increase the capacity of care.

Utah is in a very serious situation. COVID-19 is the most devastating when hospitals are overwhelmed and unable to provide good care to everyone who needs it. We have seen this in Italy. We have seen this in New York. We could see this in Utah if things do not change.

— Gov. Gary Herbert (@GovHerbert) October 29, 2020

This is why we require masks and limit gatherings to 10 or less in the vast majority of the state, and in all counties along the Wasatch Front.

— Gov. Gary Herbert (@GovHerbert) October 29, 2020

“The work is hard, it is endless and we embrace it. We don’t shy away from it, but despite those best efforts, health care is still finite — these continuous efforts may fall short,” Shah explained. “They may not meet the demand of patients if this community spread goes unchecked — which brings us to crisis care.”

Shah said it is not a good place to be.

“We need to understand that we are forced into crisis care. We don’t fall into it because of our choosing. The only choice we really have is how we respond to it,” he said. “I have worked under crisis conditions myself and I understand firsthand the negative impact it has on patients and also on providers, myself included.”

Utah has had an ongoing plan for crisis care, according to Shah.

“It provides a set of guidelines that have been developed over years and refined over months, through expert consensus from physicians from many disciplines, including intensive care, trauma, emergency medicine and also others that are expert in things like ethics and palliative care and emergency management,” he said.

Shah said the guidelines are transparent and help will help avoid unfair bias against the elderly or people with chronic health conditions. He also emphasized that crisis standards are patient-focused.

“They start with goals of care. This is something that’s important every day,” Shah said. “The most care is not always the right care and that we want individuals to have ownership over how they would like to live their lives, in particular, if they are later in their expected age, we want them to be the director of what they think is best.”

Shah added that the goal is to empower the patient which means the goal of the care takes priority. “It is always regrettable to provide care that a patient does not want,” Shah said.

He has recommended using a crisis triage officer who gets expert training.

“They can be the decision-maker, removing that decision from individual providers and individual nurses to ensure proper application of the guidance and also that that guidance be applied fairly and equitably, not just across a single hospital, but across a health care system and indeed, across the state,” Shah said.

Crisis care is something that is planned for, but Shah said it is also something leaders have been trying to avoid.

He said state leaders have chosen to unify and lift the state out of this dire situation.

“You each have a choice to make as well. To unify around this mission (or) we can continue to argue and disagree about lots of things — politics and sports, the upcoming election. We cannot continue to argue about masking, we cannot continue to argue about whether this pandemic is real or made up and we cannot continue to argue that health care will do just fine regardless of the demand,” Shah said.

The state has compiled a website that thoroughly explains COVID-19 guidelines and lists several resources to help navigate the pandemic.