Another pitfall when it comes to crisis standards of care is that they don’t necessarily make sure clinicians have visibility on everyone in emergency departments across the state who need help.
“They’re really good for a single facility deciding who goes on dialysis,” Dr. Zink says. “But from a state perspective, if you don’t have awareness that a patient in a rural community needs dialysis because that clinician was told there’s no bed availability, then we don’t know that person’s out there and we can’t try to solve that problem.”
Scrambling to find creative solutions saved lives. In Alaska, they offloaded overcrowded urban hospitals facing oxygen shortages by back-transferring patients to rural centers. The hospital where Dr. Zink practices, an hour outside of Anchorage, rarely receives patients from other hospitals, but during the pandemic when it had availability, it became commonplace to accept patients from hospitals around the state—and sometimes from hospitals hundreds of miles away. They had to set up different processes for accepting patients, and the state ended up purchasing dialysis machines for their hospital and others. “In consultation with nephrology, we were able to expand the number of hospitals that had dialysis capacity during our surge,” says Dr. Zink, adding that the state brought in 477 additional health care workers, from nurses to respiratory therapists, from around the United States to help them expand capacity. They also juggled patients, when necessary, transferring more stable patients who required less oxygen back to smaller hospitals as well as locating outpatient dialysis for patients who needed it.
In another change during the pandemic in Alaska, the state now has a website with a dashboard showing the availability of beds at each of the 26 hospitals in the state. Whether it’s ICU beds, med/surg beds, or psychiatric beds, every emergency physician in the state can see what’s available and where instead of calling around.
Burnout
Anne Zink, MD, FACEP 0
With repeated surges comes burnout. One of the biggest challenges to emergency departments is that the tools traditionally applied to crisis standards of care do not take into account the length of time the pandemic has dragged on, the many months hospital systems have been overwhelmed, and the inevitable fatigue for health care workers.
“You can’t just have people be in emergency or crisis mode for three months straight. As humans, we need to sleep, we need to care for each other. It’s impossible to be in that crisis response full time,” Dr. Zink says. “This is where hospitals have had to lean into systems changes to make sure they’re able to get the care they need.”
Dr. Gray-Eurom says her hospital’s Center for Healthy Minds and Practice saw a surge in use throughout the pandemic. Across all types of employees, she says, there were increases in burnout, relationship challenges, and other stress-related factors. The center provides free, confidential, and unlimited behavioral therapy to all employees as well as develops and maintains a peer-support counseling network to widen the available safety net to employees experiencing acute adversity.
With the most recent surge in Alaska, Dr. Zink says she is hopeful her team has improved the ways they think about caring for everyone in the state, including the transfer of patients, as well as improved their understanding and awareness of statewide resources.
“I do think that the hospitals, emergency medicine physicians, and the subspecialists like hospitalist groups have a much better understanding of each other’s capabilities, capacities, limitations, and their willingness to work together to solve problems,” she says. “I think this is helpful and will extend long past the pandemic.”
References
- Hick J. L., D Hanfling, M. K. Wynia,et al. 2020. Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2. NAM Perspectives. Discussion paper. National Academy of Medicine. Washington, DC.
- Nursing shortage. American Association of Colleges of Nursing website. Accessed Dec. 22, 2021.
- Mental health and wellness survey 3. ANA Enterprise website. Accessed Dec. 22, 2021.
Pages: 1 2 3 4 | Single Page
No Responses to “Crisis Emergency Department Challenges in a Long Pandemic”