As evidenced by several predictive models (which have a good track record) Arizona is now headed head-long into our second COVID-19 hospital overcapacity crisis.
There were several opportunities to implement interventions to prevent the crisis (see this blog post from last week), but those opportunities were passed over by Arizona’s governor and public health director. We can expect to see a pattern of events in the new weeks as we press headlong into the crisis.
First, we will see hospitals restrict visitation. That happened last week as several hospital systems implemented varying types of visitation limits.
Second, we can expect to see increasing numbers of patient transfers between hospitals as they try to level out patient loads when they have periods of time. Some hospital systems like Banner are large enough to do interfacility transfers using their own resources and data. Others will need to contact the ADHS Surge Line, where transfers can be facilitated. I’ve been told that in recent days the Surge Line has been activated to facilitate patient transfers.
Third, we will see hospitals begin to restrict elective procedures. This isn’t something hospitals like to do because patients really need these important procedures and because general surgery and elective procedures contribute much to the financial bottom-line. Nevertheless, these procedures will begin to be postponed or canceled. This is probably already happening.
Fourth, we will see hospitals change their admission decisions. For example, persons presenting in the emergency department may be sent home when, under normal circumstances, they would be admitted. Likewise, a patient that would normally be admitted to an Intensive Care Unit (with robust staffing rations) might instead be placed on a general ward bed.
Fifth, hospitals will change their discharge decisions. People that have been admitted and who would normally stay for a couple more days will be discharged rather than observed. In some cases, persons that are in the ICU may be discharged directly to home rather than admitted to a general ward bed. Others will be discharged to a skilled nursing facility rather than a general ward hospital bed.
Finally, the system will become totally saturated and the hospitals will ask the ADHS to activate the Crisis Standards of Care. “Crisis Standards of Care” is basically a protocol for making healthcare decisions when the system can’t provide all of the care that everybody needs because the needs outstrip the resources. Ethics panel discussions will be held to make very difficult decisions regarding who will get care and who will not.
The Crisis Standards of Care is a protocol to help healthcare providers objectively decide who gets care when resources don’t allow everyone to get treatment. This blog post fleshes it out How Will Patients Be Prioritized Under the New “Crisis Standards of Care”.
Here’s a link to the ADHS Crisis Standards of Care Planning Document. It’s 141 pages, but the real heady stuff is on pages 29 through 38 where it discusses the scoring system to prioritize which patients will get treatment and which will not and how to ration care to all patients when resources are outstripped by demand.
The ADHS also has an Addendum to the report called Allocation of Scarce Resources in Acute Care Facilities Recommended for Approval by State Disaster Medical Advisory Committee.
That Addendum was the subject of a complaint filed by disability rights advocates for violating the rights of persons with disabilities (on July 17, 2020). I don’t think the Addendum was modified as a result of that complaint.
Grim stuff… but it’s where we’re headed because of the decisions made and not made over the last couple of months by Arizona’s Executive Branch.