OMAHA, Neb. (KMTV) – Hospitals are unlikely to be overwhelmed by this coronavirus pandemic to the point where they need to screen patients, some health officials say.
But they say that should it happen, Nebraska’s ethical framework and crisis management plan are now ready.
“I would say we are unlikely to reach a point where we need to implement crisis standards for care,” said Dr. Cliff Roberston, CEO of CHI, on November 24th. “It is a possibility.”
Since then, Nebraska’s COVID-19 hospital stays have improved.
Key health care players in the state have endorsed a Crisis Standards Plan for Nursing, which was drawn up and reviewed by a large team of specialists in November. In the spring, hospitals in the metropolitan area approved a plan that was less comprehensive and detailed.
“The numbers reached a point we were concerned about (early November), said Rachel Lookadoo, who helped develop the plan and is director of legal and health care at the Center for Preparedness Education at the University of Nebraska Medical Center. “It’s a good idea to have this plan in place regardless.”
Nebraska Medicine, CHI, and Methodist announced their support in a joint statement approved by the Nebraska Hospital Association and the Nebraska Medical Association.
The statement said the plan is “a proactive and much-needed move not only for health care providers in our state, but especially for the citizens of Nebraska.”
“Patients seeking care across the state are guaranteed fair and consistent treatment regardless of where they live or where they seek care. If and when we reach a point in our fight against COVID-19 – we are NOT there yet – the implementation of the crisis standards for nursing care signals that we are facing a point of scarce resource allocation. By having a crisis standard of nursing plan based on sound ethical principles, triage teams will use the plan as a guide for such allocation and remove these difficult decisions from the nursing team. “
The overall goal is to ensure that “the best is done for most patients,” said Lookadoo.
That means prioritizing people who are more likely to survive. Among people in need of a ventilator, the first to lose it are the least likely to survive. It’s not an arbitrary decision: there would be a graduated scoring system using a modified version of a score called a Sequential Organ Failure Assessment.
Triage teams would be responsible for making the tough decisions and implementing the system. This is done to minimize the moral burden on the caregiver. This would allow them to focus on caring for themselves.
The plan calls for transparency to the public when the crisis standards are activated.
It is also clear which traits do not play a role in rationing care, including race, disability, gender identity, sexual orientation, and perceived quality of life. The plan aims to ensure that everyone has an equal chance of treatment and that care is not provided on a first come, first served basis.
Much of the planning is primarily about avoiding the need for crisis standards for care. Nebraska has six health coalitions linking facilities in the area, Lookado said.
The team that developed the Crisis Standards of Care plan also set up the Nebraska Medical Emergency Operations Center.
“It leads to more collaboration … to make sure we connect dots and do what we need to do to fill in the gaps when we have,” said Abigail Lowe, who also helped develop the plan and is a specialist in ethics and preparedness for the UNMC.
Nebraska’s plan is not supported by the state government. Governor Pete Ricketts says he does not have the authority to approve the plan. State Senator Sara Howard of Omaha proposed a special legislative term to give the governor this power. According to the Nebraska Hospital Association, Nebraska is one of 13 states that have no state-supported crisis standards for care plan.
A government-sponsored plan would create “an additional level” of confidence in the nationwide cohesion of a plan, said Stephen Doran, bioethicist for the Archdiocese of Omaha. Confidence in the cohesion of the plan is already high.
The plan has three levels of care: conventional, emergency and crisis. While the hospitals in Nebraska have not reached crisis levels, they have been at emergency levels. For example, some hospitals have had to set up intensive care units in locations that are not normally used for intensive care, Doran said.
If the care that is normally received is denied, an explanation will be given to the family or emergency contact, the document says.
The full plan on crisis standards for nursing is here.
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