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Nebraska Medicine moves to ‘crisis standards of care’ status

Published: Jan. 13, 2022 at 9:42 AM CST|Updated: Jan. 13, 2022 at 9:43 AM CST
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OMAHA, Neb. (WOWT) - Nebraska Medicine enacted its Crisis Standards of Care plan, effective at 9 a.m. Thursday.

“Our leadership made the difficult decision to activate this plan now because our community’s demand for health care currently exceeds our available resources,” the hospital statement says.

Doctors at Nebraska Medicine told 6 News that the plan had to be enacted to make sure non-COVID patients could continue to receive care.

A hospital spokesman emphasized to 6 News that the current number of staff absences is also a factor in the decision.

Because of the unprecedented demand for health care and the severity of the omicron variant, Nebraska Medicine has enacted its Crisis Standards of Care plan. Here is what that means for the community:

Posted by Nebraska Medicine on Thursday, January 13, 2022

On a Zoom call shortly after the status announcement, hospital officials said that they have seen a 10-fold increase in absence in recent weeks, which doesn’t necessarily mean that staff themselves are sick but that, in many cases, someone in their household is sick and they are required to isolate or are needed to care for that other person.

Patients were advised that while emergency rooms will remain open, the move could prompt rescheduling or lack of appointments, postponement of surgeries, denial of patient transfers, deployment of medical students into support roles, and use of irregular patient care areas.

This is the first time the hospital has enacted this level of care, according to members of Nebraska Medicine’s leadership team on Thursday’s call.

“That said, we’ve anticipated this day could come, and we’ve prepared for this event,” one official said.

Dr. James Linder said the status change was made in a preventative mindset, with an eye on patient safety, preparations, and transparency.

“We’ve not yet reached the COVID-19 spike in our community, and this operational status positions us to respond to any spikes in the number of cases that we have to care for in the community and doing so in a safe manner,” he said.

The shift allows Nebraska Medicine to “flex” their staff to care for more patients, should that become necessary, Dr. Linder said.

Nebraska Medicine Chief Operations Officer Cory Shaw talked about the stress of the omicron variant on the hospitals.

“It really comes down to the judgment of the clinician to decide where a patient stands within that continuum,” he said. “What might be a B-case for one patient might be a C-case or a D-case. Again, it depends upon the clinical condition, the evaluation of that physician... and their judgment as it relates to that patient’s needs.”

Dr. Harris Frankel, chief medical officer for Nebraska Medicine, said some clinics also may not be available.

“Well it certainly is possible appointments could be delayed and or rescheduled,” he said. “There may be fewer appointments for diagnostic testing in our ambulatory clinics based upon staffing availability.”

While hospitals in other states have had assistance from the National Guard, Nebraska Medicine officials said they have not had that discussion with the governor or any other state official.

“We haven’t had that conversation directly, but I’ll point out that one of the challenges that we have is that the National Guard of Nebraska is comprised of Nebraska citizens, and those Nebraska citizens that have healthcare backgrounds are likely working for healthcare organizations as we speak.”

BRYAN HEALTH: Bryan Health, based in Lincoln, said Thursday they had been operating at similar levels since July, reassigning staff to new roles to support clinical teams and limiting some procedures, “just as we have periodically over the last two years.”

The health system is also taking a critical look at transfer acceptance priorities, according to a statement sent out Thursday, but clarified in a separate statement that the hospital system had not put Crisis Standards of Care into effect.

“Unfortunately, we have been unable to accept all patients that need the elevated level of care Bryan Medical Center can provide under normal situations,” Bryan says.

Thursday’s statement also mentions that Bryan has been coping with increasing staff absences related to COVID-19, as officials in other hospital systems have reported.

“To be clear, we need everyone’s help in fighting this latest surge. Please be safe and minimize activities that increase the risk for injury or illness. Please wear a face mask, please wash your hands frequently, please avoid large crowds, and if imminent treatment is not needed, please stay home if you are sick,” the letter states, also urging the public to wear masks and get vaccinated.

CHI HEALTH: A CHI Health spokesperson noted Thursday that its hospitals had not implemented the same care level, noting that they were remaining in “contingency care” which keeps them agile as patient needs arise.

“CHI Health is NOT enacting Crisis Standards of Care. Our 14 hospitals in Nebraska and southwest Iowa are stretched thin, but our staff continue to provide heroic care to the communities we serve. We are in contingency care, which means we adapt daily to patients, staffing and bed availability. Our patient load and our staffing needs have grown exponentially. Currently, we have 223 COVID-19 patients in the hospital. 91 percent of those on ventilators are not vaccinated. Omicron is impacting our workforce. Currently we have 379 employees out quarantining or have tested positive for COVID-19. This definitely puts a stress on our system.

Throughout the pandemic, we have been evaluating surgeries based on critical needs of each patient — delaying cases that can safely wait. That has not changed.

Our message to the community — we are entering into a critical phase. We need your help. If you haven’t been vaccinated, please consider doing so and please mask up for your friends and family.”

Statement from CHI Health

Correction: A previous version of this story referred to the specific status of care at Nebraska Medicine and Bryan Health incorrectly. 6 News regrets the error.

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