From April through June 2020, New York City hospitals were overwhelmed by COVID-19 patients, and now, a working group of 15 hospital intensive care unit directors and the Johns Hopkins Center for Health Security have reported on the successes and failures of that time.
“Crisis Standards of Care: Lessons from New York City Hospitals’ COVID-19 Experience” determined that crisis standards of care (CSC) planning did not always match actual clinical needs during the pandemic, and though the response to surging COVID-19 cases was effective, it was often chaotic. Notably, this was the first time CSC measures were implemented by hospitals on a large and prolonged scale since their development by the National Academy of Medicine 11 years ago.
As hospitals shifted from conventional standards of care, inter-hospital collaboration proved successful even as situational awareness stumbled. Decision-making for triage and allocation of life-sustaining care proved difficult for many to process, and healthcare workers themselves proved very susceptible to and affected by the psychological strain of dealing with CSC issues as the surge continued.
The researchers determined that the lessons from this time could help other hospital systems, however, as COVID-19 hospitalizations rapidly rise again across the country. They believe that CSC planning needs to be more operational, with greater involvement from clinicians, who need to be shown that the process is not limited to things like ventilator triage. The researchers stated that it is essentially about making the best decision when in an unfamiliar situation involving risk to a patient or provider.
A formal declaration is needed for crises — one that clearly lays out guidance about the scope of the declaration and the researchers or processes to which it applies. Better situational awareness of patient load, resources, and changing guidance is necessary, and so are ways of inter-staff communication. Speed is key, and as such, triage decisions should be taken out of committee hands and instead involve the treating physician and others. Emotional support for healthcare workers is needed, but so is planning for staff shortages as the pandemic wreaks its toll.
Critical staff shortages are likely to remain the greatest challenge for the foreseeable future, the report concluded.