UPDATED JAN. 25, 2021: Contingency and crisis standards of care
Normally, hospitals operate under conventional standards of care, in which care is provided to patients without any changes in daily practice. During demand surges like those seen annually during cold and flu season, hospitals might alter their staffing by having physicians cover different departments, or temporarily divert ambulances to other hospitals, but staff all still work within their scope of expertise and follow standard protocols regarding who gets care and what sorts of treatments or therapies patients might receive. Patients who show up needing care still receive it.
When demand starts to exceed space and staffing resources, hospitals transition to a contingency standard of care. They change their daily practices to do whatever possible to maintain their normal standard of care. Space gets used differently, so an operating room might become a makeshift intensive care unit. Non-emergency procedures or surgeries might get postponed or cancelled. Supplies are conserved, so providers make different decisions regarding who might receive a particular therapy and change their admission and discharge procedures. A person who would normally be admitted could instead be sent home, while someone already hospitalized might be sent home sooner. Patients may be transferred between hospitals in the same city, or even to another city via the ADHS Surge Line.
Arizona hospitals are currently operating under contingency standards of care.
When the demand for healthcare exceeds hospitals’ ability to provide that care, hospitals move into Crisis Standards of Care. This is a protocol adopted when the healthcare system is unable to provide the care that everyone needs because there are simply not enough resources or staff to take care of everyone who needs it. Hospitals are forced to make substantial changes to the way that they provide care. Providers often work outside their normal scope of practice, and supplies may need to be reused or may become completely unavailable. Supplies including medications or oxygen may become unavailable. Crisis Standards of Care also provide a protocol by which providers determine how limited care is to be rationed, and how decisions determining which patients receive treatment and which will not are to be made.
In response to the COVID-19 pandemic, Arizona authorized Crisis Standards of Care for hospitals in early July of 2020.
The best ways to help protect our hospitals and help avoid Crisis Standards of Care are continuance of the same steps we are already using to
protect ourselves and our families. Wearing a mask, avoiding close contact with others, handwashing, staying home when sick, and getting vaccinated are our best tools for keeping our community safe.
Sources:
Arizona Crisis Standards of Care Plan (PDF) AZDHS, 2020.
ADHS Surge Line ADHS
COVID-19 Addendum: Allocation of Scarce Resources in Acute Care Facilities (PDF) ADHS, 6/12/20.
Arizona Authorizes Crisis Standards of Care Patient Triage Protocol AZ Public Health Association, 07/6/20.