Ballad’s worst-case COVID-19 contingency plan includes a “triage team” to determine who receives life-saving care | WJHL

JOHNSON CITY, Tenn. (WJHL) – Ballad Health is preparing for a worst-case scenario of COVID-19: What to do when the number of patients requiring certain types of care exceeds the resources needed to provide that care.

The head of the area’s only hospital system says the teams are working to make sure this doesn’t happen while developing a plan and communicating in case it does.

“It’s something we hope doesn’t happen, but we are very transparent about it,” said Alan Levine, President and CEO of Ballad Health.

This confirmation comes as Ballad Health reports that it is currently treating nearly 300 COVID-19 patients and that number will rise to 400 in the next few days.

As a result, Ballad’s staff are currently being trained on the protocol when critical resources become scarce due to an increase in sick patients, including people with COVID-19, Levine said.

“We’re going to do all we can for every patient we have,” said Levine. But when you don’t have a resource, this is the decision you have to make. We don’t want it to be a guessing game. “

Under the latest plan, when resources like ventilators, supplemental oxygen, BiPAP and CPAP machines, IV pumps, and life-saving medications run out, patients admitted to Ballad hospitals will receive a letter telling them that the Hospitals are overwhelmed by COVID -19 patients may not have these potentially life-saving resources for everyone.

The Scarce Resource Plan is not currently being deployed, and the Patient Notification Letter for Allocating Scarce Resources is not currently being given to patients, Ballad Health says.

“For example, if we find that we have run out of ventilators and we can’t get any more ventilators, you have to decide who gets the ventilator,” Levine said.

According to the patient’s letter, this decision would be made by a so-called “triage team” consisting of clinical and administrative staff.

READ THE LETTER HERE:

This triage team would assign a priority color code to patients. The letter stated that the code would “determine the order in which you were given access to a scarce resource based on your clinical condition.”

After the triage team assessed factors such as age and medical history, priority would be given to those most likely to survive treatment and the letter stated, “In the event of inequality between adults and children, the child would be awarded. “

Levine said the process is ethically driven and overseen by the Ballad Health Clinical Council, which, with the approval of the Ballad Health Board of Directors, adopted “Guidelines for Allocating Scarce Resources Under Emergency Care Standards.”

“If you dedicate the resource to someone less likely to survive, you could lose someone who could have lived,” Levine said. “So what drives the decision is who is most critical and who is most likely to benefit from it.”

The “Resource Allocation Patient Notification Letter” also describes what happens after resource scarcity has been allocated.

“If you are assigned a scarce resource, your priority rating will be recalculated 48 and 120 hours after the initial decision and your progress will be assessed,” the letter said. “If you have not improved or your condition has worsened, your access to the life-saving scarce resource may be withdrawn and assigned to a patient who is more likely to survive hospital discharge and you and your family will be referred to palliative care by Ballad Health referred provider. “

Levine said the patient’s doctors, in consultation with the family, would be the patient’s advocates and have the opportunity to appeal against decisions made by the triage team.

While Levine said hospitals in other parts of the country are already using resource allocation plans, he wouldn’t speculate on if or when that might happen at Ballad Health.

“We think it is more responsible to be proactive so that we don’t act reflexively when it happens,” he said. “We make good decisions based on evidence, best practices and what is in the best interests of patients.”

Ballad recently suspended all elective surgeries to free up resources to care for critically ill patients, and Ballad has just purchased 50 new ventilators, Levine confirmed.

“The point is when you get to the point where you can’t do this anymore, you have to make these tough decisions,” he said.