In my prior post on estimating volume, I referred to the Institute of Medicine’s 2012 Report on Crisis Standards of Care (CSC). That report provided a framework for Crisis Standards of Care, which included the following main categories:
- Ethical Considerations
- Community and provider engagement, education, and communication
- Legal authority and environment
- Indicators and triggors
- Clinical process and operations
As we engage our medical staff to support growing COVID-19 inpatient and ED volume, it is critical to keep in mind ethical and also legal considerations. Concerns related to both of these elements of the framework will arise. Consider for a moment the ethical considerations, which includes the components of fairness, duty to care, proportionality, duty to steward resources, transparency, accountability and consistency. How relevant these principles of Crisis Standards of Care have become so pertinent in our life. Having primary care physicians, for example, participate in the care of inpatients or in the care of patients in the emergency department needs to be well thought out. Many questions naturally arise that can call into question the appropriateness of your disaster staffing plan, which is why it is important to consider these issues now. Having a clear and consistent message to all medical staff that we, as a medical staff, take our responsibility and the duty to care seriously, and this means we will all participate being part of the solution for COVID-19. For some, this may mean phone-based triage, for others, this may mean staffing an urgent care, others may be asked to see inpatients and in some cases transition from a consultative role to the role as a primary attending. By clearly communicating now that we are all in this together, we immediately set the tone for the seven tenets of the Crisis Standards of Care, and make the path forward more clairvoyant and deliberate.