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What does a health care ration look like during a COVID-19 surge?


Important point

  • Hospitals in some locations are full due to the ever-increasing number of COVID-19 cases nationwide.
  • If the healthcare system faces overwhelming demand for hospital beds, medicines, ventilators, or healthcare providers, they may need to distribute their resources.
  • Many hospitals choose ration care based on their chances of survival, but hospitals take a different approach to this.

Many hospitals in the United States face extreme shortages as they exceed their ability to treat all patients in need of treatment during the COVID-19 surge.

Man died this week A heart event after hospital staff in northern Alabama contacted 43 hospitals in three states and found a bed in the cardiac care unit for him.In Idaho, public health officials announced State-wide medical distributionThat is, the ICU bed is reserved for patients who are most likely to survive.

Over 93,000 beds nationwide are filled with COVID-19 patients. According to the Department of Health and Human Services, about 80% of ICU beds are used and 79% of all hospital beds are currently full nationwide.

Delta variants are driving a surge in hospitalizations, especially among unvaccinated individuals. Almost 37% of Americans eligible to take a shot have not yet been fully vaccinated.

As healthcare center resources become increasingly tense, hospitals face increasingly tough decisions about which patients prioritize care.

What does that mean for ration medicine?

In medicine, “distribution“” Means that access to care for a particular group is restricted. In a sense, medical care in the United States is already rationed. For example, a health insurance company may not cover a particular treatment or procedure, and uninsured or out-of-pocket people may not have access to care.

During a medical crisis such as the COVID-19 pandemic, the medical care of people with urgent medical needs can be limited by their total need.

“We only have a certain number of licensed beds or operating rooms. We only store a certain amount of antibiotics or analgesics and a certain number of ventilators on site,” he said. I have. Lewis Kaplan Doctor of Medicine, Former President of the Society of Critical Care Medicine and Professor of Surgery at the University of Pennsylvania.

“When we run out of space, no one to provide care, or no cure, we have space for rations,” Kaplan tells Berrywell.

Hospitals have common practices on how to deal with patient overflows and expand resources in limited cases. However, unlike scenarios such as natural disasters, where the influx of emergency medical demand will eventually decline, the burden on hospitals during the pandemic continues. Hamad Hussiny, DO, FACEP, Alabama Emergency Department Physician and Chief Medical Officer of Sycamore Physician Contracting.

Not only does COVID-19 increase the number of patients who require intensive care, but it also tends to increase hospital stays. The median length of stay for COVID-19 patients admitted to the ICU is 7 days compared to 1 day for patients admitted in 2019. Nuffield Trust, British health think tank.

“What we are seeing now is that the outbreak of sick people is getting longer and longer, and that leaves us to say,’Is this over? Is this a new normal? “Husainy says.

How hospitals deal with overflow

Expanding physical capacity is difficult and expensive, and hospitals cannot be built overnight, Husainy adds.

When a hospital reaches capacity in its standard settings, it may take the following steps: Pause of elective surgeryRemodel the cafeteria and corridors to accommodate overflowing patients.

Even if hospitals have the flexibility to use physical resources, they still need enough providers to care for those patients. Increased stress on medical staff during the 17-month pandemic Already confused Nursing labor market.

Some medical systems are accelerating training programs for clinicians and require others to perform non-conventional duties. Hospital staff who are required to take on more patients are more likely to face burnout.

“Patients cannot be placed in a room without a nurse to staff,” says Husainy. “There was a situation where the patient ended up in the corridor or something of its nature. But with a nurse who was already stressed, giving him or her 9 or 10 patients, including the patient in the corridor, You can’t expect them to appear at work next week. “

When a hospital is fully occupied, patients may be transferred to another hospital with more capacity.However, in areas where most medical systems are overloaded, it can be difficult to find open beds or specialists to perform certain procedures, and patients can transport hundreds of patients. there is Miles away..

If the situation is particularly dire, the clinician will follow the rubric to determine who prioritizes care. Details vary by health care system, but people who are most likely to survive in response to treatment are usually preferred.

Kaplan explains that first-come-first-served and age-based rations are not the most effective rations.

“You probably know a 74-year-old who has one comorbidity, is fairly healthy, lives independently, and has an aggression-sharp heart. Also, undergo a liquid organ transplant. I also know a 26-year-old who has five comorbidities and is using immunosuppressive drugs, “says Kaplan. “These are very different patients. How would you describe them all?”

Kaplan says a committee of experts will determine an objective rubric for allocating resources. Bioethicists, clinicians, and others By factor Life expectancy of the patient, pregnancy status, and the role of the patient in society.

“The person who holds your hand, talks to your loved one, and looks into your eyes is not the one who decides. You can imagine how many conflicts will occur,” says Kaplan.

In addition, care should be distributed based on the patient’s prognosis rather than the behavioral decisions made by the patient.under Emergency medical care and labor lawNo one can refuse emergency care, regardless of why they need it or their ability to pay.

What this means to you

Certain selective treatments can be suspended, which can make access to emergency care more difficult, especially if the health care system in your area is particularly tense. The best way to avoid hospitalization with COVID-19 is to be fully vaccinated.

Find a loophole

6-part COVID-19 Mediation Plan Announced last week, President Joe Biden Said The Pentagon has promised to double the number of healthcare providers sent to hospitals that have been hit to assist clinicians in responding to a surge in patients.

Husainy says this support is appreciated, but it’s just a “bucket drop”. If additional clinicians were assigned to all hospitals that needed them, he said they would need to serve almost every medical center in the southeast.

Increasing the COVID-19 vaccination rate is the best way to keep people away from the hospital, says Husainy, and he has not yet seen patients vaccinated in his own practice.

“The best thing, and this is the approach I took. Very kind and honest to the individual,” We will do everything we can to make you feel better. We encourage you to share your vaccinations with your loved ones and influential people, “says Husainy. “It’s my moment that makes a difference with the next patient.”

“In reality, we all work in our hometown of America. Whether it’s a city or a countryside, we can only change one person at a time,” he adds.

The information in this article is up to date as of the date stated. In other words, reading this may provide new information. For the latest update of COVID-19, Coronavirus news page..




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