The Oregon Health Authority (OHA) has provided the state’s hospitals with an interim crisis care tool to help them prioritize treatment if they reach a point when critical care beds, specialized equipment, such as ventilators, and other resources become scarce due to surging COVID-19 admissions.
Oregon hospitals may activate crisis standards of care if their critical care resources are severely limited, the number of patients presenting for critical care exceeds capacity, and there is no option to transfer patients to other critical care facilities, according to a release from the OHA.
Hospitals may implement OHA’s interim crisis care tool - or one of their own that is consistent with Oregon’s Principles in Promoting Health Equity in Resource Constrained Events - if they have taken specific steps to extend their capacity to deliver care. Those steps include stockpiling supplies, delaying non-urgent care, and repurposing existing beds and staff that are not typically used to provide critical care.
Under the interim triage tool, all patients who can potentially benefit from treatment will be offered care, if health care resources are sufficient. If hospital staff, beds and treatment are insufficient, all patients will be individually assessed according to the best available objective medical evidence. According to the tool:
- No one will be denied care based on stereotypes, assumptions about any individual’s quality of life, or judgement about an individual’s “worth” based on the presence or absence of disabilities.
- Care decisions should be based on the likelihood of survival to hospital discharge.
Under Oregon’s interim crisis care standards, state health officials expect providers to treat all patients with respect, care and compassion. Hospital clinicians may not base care decisions on an individual’s use of past or future medical or social resources. They should apply reasonable modifications to any triage scoring criteria when considering individuals with underlying disabilities or certain underlying health conditions, according to the release.
Triage decisions will be made without regard to morally or scientifically irrelevant considerations such as income, race, ethnicity, gender identity, sexual orientation, immigration status, health insurance coverage or other factors.
The OHA said it has developed the interim tool based on several existing triage tools, such as those published by Arizona, Massachusetts and Washington state. State health officials made adjustments according to Oregon’s health equity principles of non-discrimination, patient-led decision making and transparent communications.
State health officials said they had consulted a limited group of clinicians, medical ethicists, disability advocates and others before releasing the interim triage tool.
Oregon remains committed to developing a permanent tool based on broader community input, according to OHA chief Medical Officer Dana Hargunani.
“Right now, we want to put a triage tool in the hands of clinicians who are likely to face very difficult decisions in the coming weeks, as the Omicron variant takes its toll and puts more patients in the hospital," Hargunani said. "This interim tool isn’t perfect, but it ensures that clinicians can be confident they are using criteria firmly grounded in Oregon’s values of non-discrimination and health equity as they face these gut-wrenching decisions.”
At the same time, OHA also is calling for applicants today to serve on a new Oregon Resource Allocation Advisory Committee.
The Oregon Resource Allocation Advisory Committee’s role will be to:
- Review and inform updates to OHA’s Principles in Promoting Health Equity During Resource-Constrained Events, which ensures health equity in decision-making when resource shortages occur.
- Review and inform future amendments or changes to the interim crisis care tool.
- Guide development of any additional necessary resources – including triage tools, guidance, best practices – to ensure these principles can be readily applied in Oregon during a resource-constrained event.
- Inform the norms and expectations regarding patient communication and transparency when health system allocation decisions are necessary due to resources constraints.
OHA is seeking applicants representing: the state’s health care delivery system, including hospitals, health care providers and local public health agencies; and organizations and community members who can speak to community needs, especially communities of color, tribal communities and people with disabilities, including people with intellectual and developmental disabilities.
The committee will meet virtually once or twice a month over nine to 12 months and will be supported by a project team and a contracted facilitator. Care will be taken to support a trauma-informed, collaborative and inclusive process that recognizes the diversity of professional and lived experiences among committee members.
For individuals with disabilities or individuals who speak limited English, OHA will provide free help during advisory committee meetings, such as with sign language and spoken language interpreters, real-time captioning, braille, large print, audio, and written materials in other languages.
Those interested in applying to serve on the committee should contact the OHA for an application form. Deadline to submit the form is Jan. 28, 2022.
If you have questions about the committee or need assistance completing the application, contact OHA at OHAResourceallocation@dhsoha.state.or.us. OHA will select members and communicate to all applicants in February. Members will be selected to ensure diverse community representation, health care delivery expertise, geographic diversity and lived experience.