During a COVID-19 Surge, ‘Crisis Standards of Care’ Involve Excruciating Choices and Impossible Ethical Decisions for Hospital Staff

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During a COVID-19 Surge, ‘Crisis Standards of Care’ Involve Excruciating Choices and Impossible Ethical Decisions for Hospital Staff
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Amid the latest surge of COVID-19 cases, health care workers yet again are having to make difficult triage decisions in caring for patients.

So, those of us in the health care system are hitting our breaking point again. And when hospitals are full, we are forced into making triage decisions.Our health system in Colorado is now assuming that by the end of December, we could be 10% over capacity across all our hospitals, in both intensive care units and regular floors.

But where are we going to get regular hospital rooms for these patients with DKA, since those are full too? Here’s what we might do: People with serious infections due to IV drug use are regularly kept in the hospital while they receive long courses of IV antibiotics. This is because if they were to use an IV catheter to inject drugs at home, it could be very dangerous, even deadly. But under triage conditions, we might let them go home if they promise not to use their IV line to inject drugs.

Worse than all of this is anticipating the conversations with patients and their families. These are what I dread the most, and in the last few weeks of 2021, we’ve had to start practicing them again. How should we break the news to patients that the care they are getting isn’t what we’d like because we are overwhelmed? Here’s what we might have to say:

… at this point, it is reasonable to do a trial of treatment on the ventilator for 48 hours, to see how your dad’s lungs respond, but then we’ll need to reevaluate …

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