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OHSU Doernbecher Children’s Hospital implements crisis standards of care

This tool helps ensure patients get the best possible care as RSV hospitalizations increase
OHSU Emergency Department at Night
RSV and nurse staffing have put unprecedented stress on hospital systems throughout the state, including OHSU, limiting the ability to take patients. (OHSU/Christine Torres Hicks) 

Updated 6 p.m., Jan. 30: On Monday, Jan. 30, at 12:30 p.m., OHSU Doernbecher Children’s Hospital moved to contingency capacity and ended the declaration of crisis standards of care. The children’s hospital is still experiencing high capacity and staffing shortages. However, OHSU teams are working within their staffing plans, which has been the key criterion for this decision. 

Original post, Nov. 22: Recognizing the extreme strain on hospital resources statewide and at OHSU, and in alignment with new guidance from the Oregon Health Authority, OHSU Doernbecher Children’s Hospital has declared crisis standards of care in response to the high volume of patients with respiratory syncytial virus, or RSV, in addition to the pediatric care they provide every day.  

Declaring crisis standards of care gives us the flexibility to adjust staffing plans to allow us to staff all physical beds and take excellent care of every child that needs us. For example, nurse ratios may change in critical or acute care units. Helping hands and nurse extenders may be used to support assignments with more patients or increased acuity. This will support the regional approach to distributing patients between hospitals who can accept pediatric acute and critical care patients. 

Throughout the pandemic, OHSU has implemented surge plans in response to an influx of patients seriously ill with COVID-19 and other conditions. Therefore, OHSU has already taken steps to manage heavy demand on lifesaving health care resources and services, including addressing staffing shortages.    

According to the Oregon Health Authority, crisis standards of care are activated when patient care resources are severely limited; the number of patients presenting for care exceeds capacity; and, there is no option to transfer patients to other acute or critical care facilities. OHSU and other hospitals and health systems in the region that provide pediatric care have met those criteria.  

The formal definition of crisis standards of care has been defined by the OHA and includes a tool to help hospitals equitably allocate scarce resources and ensure OHSU is ready if a wave of patients with RSV make it impossible to provide lifesaving care to all who need it. OHSU recognizes and has planned for the possibility that patients could overwhelm Oregon hospitals, forcing decisions about available resources for care. At this time, OHSU is not making triage decisions, but it is entering crisis standards of care in order to optimize all resources, including staffing.    

For Oregon Health & Science University’s frontline health care teams, providing compassionate, high-quality caring is their calling; they show up every day to help heal people, and every single life is valued. The needs of the patient — the individual — is always at the center of their thinking and decision-making.  

OHSU’s latest forecast projects weekly hospital admissions for adult and pediatric patients with RSV to peak on Wednesday, Nov. 30. 

Continuum of care definitions  

As described in the Oregon Health Authority’s Interim Crisis Care Tool, hospitals experience surge capacity during a disaster on a care continuum. The OHA uses standard definitions from the Institute of Medicine which describe three phases of capacity status: conventional, contingency and crisis:   

  • Conventional capacity: Hospitals have the spaces, staff and supplies to meet usual daily needs for patient care.   
  • Contingency capacity: Hospitals can temporarily adjust spaces and practices to make up for a shortage of spaces, staff and supplies.   
  • Crisis capacity: Hospitals must significantly change standards of care because:   
    • Resources are severely limited.   
    • More patients need critical care than hospitals can supply.   
    • Moving patients to another critical care center is not an option.   

As more children become hospitalized with RSV, the best thing parents and caregivers can do to keep their children healthy and safe is to practice all the measures that were emphasized during the pandemic: avoid contact with those who are sick, wash hands frequently, clean and disinfect surfaces and stay up to date on all routine vaccinations, including flu shots and COVID-19 boosters. It’s also helpful to limit infants’ exposure to frequent visitors and crowds, especially if they are at risk for severe illness and/or younger than 12 weeks of age. 

Because of the high volume of sick young children requiring emergency services at this time, caregivers and families, unfortunately, may experience long wait times in our emergency departments. Additionally, appointments for urgent, immediate and primary care may take longer to schedule. Except when emergency care is needed, we urge families and caregivers with concerns to first call their primary care provider. 

OHSU thanks families for their patience as communities continue to collaborate with the state, and other hospitals and health systems around Oregon, to respond to these challenges and help ensure children have access to the care they need.   

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