Pre-pandemic crisis standards of care (CSC) planning did not always align with the realities and clinical demands of the COVID-19 pandemic as it unfolded, a report from the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health finds.
Based on discussions with a working group of fifteen ICU directors convened virtually in October in partnership with New York City Health + Hospitals, the report, Crisis Standards of Care: Lessons From New York City Hospitals' Covid-19 Experience (23 pages, PDF), found that during the surge of COVID patients in the city from April to June, healthcare workers had to overcome multiple CSC challenges — especially around triage decisions and the allocation of life-sustaining care — and were deeply affected by their experiences on a psychological level.
According to the report, situational awareness was a challenge for many clinicians. To address the problem, physician-leaders in the future will need to ensure better situational awareness of patient load and resources, change their guidance and policies, and find more effective ways to keep their staffs informed; CSC planning will need to be more operational, with clinicians more closely involved; and additional education focused on the spectrum of crisis care will have to be included in emergency preparedness exercises.
The participants also noted that staffing, a major challenge before the pandemic, has been exacerbated by the virus, is likely to continue to be the biggest challenge for the foreseeable future, and should be a high-priority issue. Indeed, given the emotional toll on healthcare workers who must make snap life-and-death decisions during a surge, ways of alleviating that burden and providing emotional support are urgently needed.
"During the [early months of the] pandemic there were overt accolades and appreciation for healthcare workers," said one participant, "but that's now gone away, and morale is back down."
(Image credit: Johns Hopkins University)