Oregon issues hospital crisis care standards as COVID surges

Oregon hospitals have new interim guidelines  to help them determine which patients should get lifesaving care if the current COVID-19 surge forces them to choose between people because of a lack of beds, staff or critical medical equipment.

The guidelines will only come into play if a hospital has exhausted all other options to treat every patient, including transfers to other facilities, delaying non-urgent surgeries and care, stockpiling supplies and repurposing existing beds and spaces for critical care patients.

The new policy comes as Oregon faces a wave of the highly contagious, but milder, COVID-19 omicron variant. The state has set new records for new cases of COVID-19 multiple times in the past week and on Thursday, state health authorities said hospitalizations were up 12% over the previous day.

There are only 42 available adult intensive care unit beds and 95% of the state’s staffed adult non-ICU beds are full, the Oregon Health Authority said. Gov. Kate Brown announced Friday she will deploy up to 500 Oregon National Guard members to help at hospitals, with the first 125 members arriving at some of the hardest-hit hospitals next week.

“Right now, we want to put a triage tool in the hands of clinicians who are likely to face very difficult decisions in the coming weeks, as the Omicron variant takes its toll and puts more patients in the hospital,” said Dana Hargunani, OHA’s chief medical officer.

Not a Modern Healthcare subscriber? Sign up today.

“This interim tool isn’t perfect, but it ensures that clinicians can be confident they are using criteria firmly grounded in Oregon’s values of non-discrimination and health equity as they face these gut-wrenching decisions.”

The agency acknowledged that the surge of omicron cases did “not allow time for the robust, comprehensive and fully inclusive community and clinician engagement needed” and that the interim standards are “imperfect.” A new committee to be established this winter will review the policy and make revisions and additions as needed, OHA said in a preface to the guidelines.

The standards are based on those developed in Arizona, Massachusetts and Washington amid the COVID-19 pandemic. They replace previous ones that were scrapped after Disability Rights Oregon, an advocacy group, filed a federal civil rights lawsuit alleging the rules discriminated against the elderly, the disabled and those with serious pre-existing illnesses.

The guidelines direct hospitals to rank patients by evaluating the likelihood of their short-term survival without judgment about their overall quality of life or long-term survival before the current illness.

In a tie between two patients who need the same resources, the person already receiving care would continue to get it, unless their condition had worsened. In ties between two patients with similar conditions presenting at the same time, hospitals would use a blind drawing to decide who gets care.

Unlike other states, Oregon’s standards do not prioritize any particular groups of people for lifesaving care. Other states, for example, award more points to pregnant people, those under 18, healthcare workers, or single parents, Oregon Public Broadcasting reported.

The prior standards allowed hospitals to exclude some people from critical care during a crisis, like those with certain stages of cancer or other serious illnesses.

Hospitals in Oregon can create their own crisis standards of care but they must adhere to the state’s rubric.