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US Hospitals Nearing Max Capacity Options
Oscar D. Grouch
Posted: Thursday, November 26, 2020 3:52:33 AM

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Near Crisis, Some Hospitals Face Tough Decisions In Caring For Floods Of Patients
November 25, 2020 6:43 PM ET

https://www.npr.org/sections/health-shots/2020/11/25/939103515/near-crisis-some-hospitals-face-tough-decisions-in-caring-for-floods-of-patients

Far more people in the U.S. are hospitalized for COVID-19 now than at any other moment of the coronavirus pandemic — more than twice as many as just a month ago.

Hospitals in some of the hardest-hit states are exhausting every health care worker, hospital room and piece of equipment to evade the worst-case scenario, when crisis plans have to be set in motion and care may have to be rationed.

Many states are warning they're on the brink. On the ground, equipment and staff shortages are already straining the system and changing how hospitals provide care. An NPR data analysis supports what health care leaders and researchers have cautioned: This stress may even be contributing to higher death rates.

"We accept a small amount of risk each time that we expand our capacities," says Dr. John Hick, a committee member of the Forum on Medical and Public Health Preparedness for Disasters and Emergencies of the National Academies of Sciences, Engineering, and Medicine. "It's not at all unexpected that we're going to have some worse outcomes."

The care crisis is already here

Hospitals have a road map for how to manage during a catastrophe. It's called crisis standards of care, and it guides clinical and ethical decisions on how to triage care when resources are tight.

It's a last resort — a fundamental change from doing everything possible for one patient to maximizing the benefits for many, says Dr. Dan Hanfling, who served on the crisis standards of care committee for NASEM with Hick.

And while most places have not officially activated crisis standards of care, hospitals are already resorting to workarounds to "maximize, to the closest extent possible, the usual standards of care," says Hanfling.

Hospital capacity expands like an "accordion," but at some point, he says, "you overwhelm even those capabilities. And you get to the point where space, staff and stuff are really not being consistent with the level of care that we are used to delivering."

Some experts believe clinicians are already informally making decisions akin to rationing care.

"There's been a lot of language around 'we're right on the edge of entering crisis capacity,' but what I'm worried about is that there's kind of a blurred entry," says Dr. Kate Butler, a nephrologist and acting instructor at the University of Washington School of Medicine.

Butler has studied how health care workers dealt with these clinical dilemmas during the spring COVID-19 surge.

"Everybody gets a little bit of bad care," said one worker she interviewed, referencing shorter dialysis sessions for patients when the machines were in high demand.

In an interview with NPR, Butler said, "there's been far less preparation for this gray zone where resources are limited, and we're seeing impact on patient care — potentially people dying — because they're not getting the care that would otherwise be offered to them."

During the current surge, hospitals are again grappling with tricky decisions around how far you can stretch care.

In Wisconsin, where the state has set up makeshift beds at the Wisconsin State Fair Park to handle mild COVID-19 cases, the Mayo Clinic Health System has moved beds into waiting rooms and even a parking garage.

"Literally every bed in northwest Wisconsin was full, and hospitals just weren't able to admit new patients," said Dr. Paul Horvath as he described a recent shift at the emergency room to Wisconsin Public Radio. "And that means that I had the challenge of managing ICU-level care in my ER for hours, which is obviously not routine."

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