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Patient Care with Scarce Medical Resources

Connie Christian, MBA, CPHRM
KAMMCO Facility Risk Management & Patient Safety Advisor
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Healthcare providers, facilities and patient safety professionals face continued pressure and new strains on already taxed resources. Ensuring the safety of patients, residents, and staff becomes increasingly complicated when there are shortages of life-saving medical equipment such as ventilators and personal protective equipment (PPE). The pressure to do more with less builds as the virus continues to spread increasing the potential for staff to become infected. Taking an enterprise risk management approach to the situation will provide guidance to protecting a facility’s financial, human and infrastructure resources. 
 
Healthcare providers and facilities may be forced to make difficult decisions related to patient care when PPE levels are low or critical care devices are in short supply. For instance, if a facility has more critically ill patients than it can manage, how does it determined who gets the intensive care bed or ventilator? Or, if a medical practice has limited PPE for its staff, what criteria will they use to prioritize which patients and which conditions should be scheduled for in-person appointments? The notion of healthcare operations continuing during a period of scarce resources is not new and has been built into many facility Emergency Operations Plans (EOPs). Below are resources to assist providers and facilities make these difficult decisions and to help them revise EOPs to meet the challenges of our current scarce resource crisis.
 
Kansas Medical Society (KMS)
KMS offers local updated information and resources on the COVID-19 pandemic in Kansas.
 
Kansas Department of Health & Environment (KHDE)
KDHE contracted with the Kansas Health Institute (KHI) to provide guidance on how to plan for the use of scarce resources during a public health emergency. This publication presents the results of an extensive review of published and unpublished material on the subject and recommendations on how to develop state and local plans for the use of scarce resources.
 
The Centers for Disease Control & Prevention (CDC)
Nationally, the CDC provides guidance to healthcare providers and facilities – along with their healthcare coalitions, local and state health departments, and local and state partners – on how they will have to work together to develop strategies to identify and extend PPE supplies, so that recommended PPE will be available when it’s needed most. When using PPE optimization strategies, training on PPE use, including proper donning and doffing procedures, must be provided to healthcare providers before they carry out patient care activities.
 
The American Medical Association (AMA)
The AMA has published Allocating Limited Healthcare Resources in its Code of Medical Ethics Opinion 11.1.3.  Physicians’ primary ethical obligation is to promote the well-being of their patients. Policies for allocating scarce healthcare resources can impede their ability to fulfill that obligation, whether those policies address situations of chronically limited resources, such as intensive care unit beds, medications, or solid organs for transplantation, or “triage” situations in times of scarcity, such as access to ventilators during a respiratory pandemic.
 
The Joint Commission
The Joint Commission has created their resource page to support healthcare professionals and organizations on the front lines of the COVID-19 pandemic. The situation is changing rapidly, and recommendations have been changing with similar speed. This page specifically addresses scarce resources and personal protective equipment guidance statements.
 
The ECRI Institute
The ECRI Institute provides multiple guidance documents on scarce resources for facilities:
 
The University of Pittsburgh Department of Critical Care Medicine
The University of Pittsburgh Department of Critical Care Medicine created guidance for the triage of critically ill patients in the event that a public health emergency creates demand for critical care resources (e.g., ventilators, critical care beds) that outstrips the supply. These triage recommendations will be enacted only if: 1) critical care capacity is, or will shortly be, overwhelmed despite taking all appropriate steps to increase the surge capacity to care for critically ill patients; and 2) a regional authority has declared a public health emergency. This allocation framework is grounded in ethical obligations that include the duty to care, duty to steward resources to optimize population health, distributive and procedural justice, and transparency. It is consistent with existing recommendations for how to allocate scarce critical care resources during a public health emergency, and has been informed by extensive consultation with citizens, disaster medicine experts, and ethicists.
 

This document should not be interpreted as medical or legal advice. Because the facts pertaining to your situation may fluctuate, or the laws in your jurisdiction might vary, please contact your attorney if you have questions related to your legal or medical obligations or rights, state or federal laws, contract interpretation, or other legal questions​.