On Brink of Capacity, Oregon Hospitals Receive Guidance on Who Receives Lifesaving Care

Hospitals in Oregon were given new interim guidelines to help them decide which patients should receive lifesaving care after a surge in COVID-19 cases put a strain on their health care system.

Hospitals are being stretched thin by the new wave of COVID-19 infections from the fast-spreading Omicron variant. They're facing a shortage of beds, staff and medical equipment.

Currently, there are only 42 adult intensive care unit beds available in the state. The adult non-ICU beds are at 95 percent capacity, the Oregon Health Authority said.

Due to the critical shortages, OHA released guidelines designed to help health care workers choose between patients who need medical treatment if they've exhausted every other option to care for patients.

The guidelines will help hospitals create a system to rank patients based on their likelihood of short-term survival.

The guidelines should only be used if a hospital has tried everything to treat all of their current patients including delaying non-emergency surgeries, transferring patients to other facilities, and reutilizing existing beds and spaces to treat critical patients.

"This interim tool isn't perfect, but it ensures that clinicians can be confident they are using criteria firmly grounded in Oregon's values of non-discrimination and health equity as they face these gut-wrenching decisions," said OHA's chief medical officer Dana Hargunani.

Hospitals Short Staffed COVID-19
Oregon hospitals were given new guidelines to determine who should receive lifesaving care after a COVID-19 surge is putting a strain on the health care system. Above, a medical worker treats a non COVID-19 patient, who is just in a room beside rooms with Covid-19 patients, in the ICU ward at UMass Memorial Medical Center in Worcester, Massachusetts, on January 4, 2022. Joseph Prezioso/ AFP/Getty Images

The new policy comes as Oregon faces a wave of the highly contagious, but milder, COVID-19 Omicron variant. The state has set new records for new cases of COVID-19 multiple times in the past week and on Thursday, state health authorities said hospitalizations were up 12 percent over the previous day.

"Right now, we want to put a triage tool in the hands of clinicians who are likely to face very difficult decisions in the coming weeks, as the Omicron variant takes its toll and puts more patients in the hospital," said Hargunani.

Governor Kate Brown announced Friday she will deploy up to 500 Oregon National Guard members to help at hospitals, with the first 125 members arriving at some of the hardest-hit hospitals next week.

The agency acknowledged that the surge of Omicron cases did "not allow time for the robust, comprehensive and fully inclusive community and clinician engagement needed" and that the interim standards are "imperfect." A new committee to be established this winter will review the policy and make revisions and additions as needed, OHA said in a preface to the guidelines.

The standards are based on those developed in Arizona, Massachusetts and Washington amid the COVID-19 pandemic. They replace previous ones that were scrapped after Disability Rights Oregon, an advocacy group, filed a federal civil rights lawsuit alleging the rules discriminated against the elderly, the disabled and those with serious pre-existing illnesses.

The guidelines direct hospitals to rank patients based on their short-term survival chances without judgment about their overall quality of life or long-term survival before the current illness.

In a tie between two patients who need the same resources, the person already receiving care would continue to get it, unless their condition had worsened. In ties between two patients with similar conditions presenting at the same time, hospitals would use a blind drawing to decide who gets care.

Unlike other states, Oregon's standards do not prioritize any particular groups of people for lifesaving care. Other states, for example, award more points to pregnant people, those under 18, health care workers, or single parents, Oregon Public Broadcasting reported.

The prior standards allowed hospitals to exclude some people from critical care during a crisis, like those with certain stages of cancer or other serious illnesses.

Hospitals in Oregon can create their own crisis standards of care but they must adhere to the state's rubric.

The Associated Press contributed to this report.

Oregon ICU
The hospitalization rate of unvaccinated COVID-19 is breaking records and squeezing hospital capacity, with several running out of room to take more patients. Above, two visitors peer into the room of a COVID-19 patient in the intensive care unit at Salem Hospital in Salem, Oregon, on August 20, 2021, as a nurse dons full protective gear before going into the room of another patient. Andrew Selsky/AP Photo