Early reports from frontline clinicians in global epicenters describing extreme shortages and bedside rationing of ventilators and intensive care unit beds prompted a national conversation about how to respond to similar challenges in the United States. Hospitals and health care systems drew on frameworks developed by the Institute of Medicine (OM) and other national organizations to guide care in resource-limited emergency settings.
Clinicians described patterns of institutional planning that mirrored the IOM’s phased approach, which assumes a common understanding of what constitutes usual standards of care with a plan for a coordinated regional response when these become untenable. However, consistent with prior anecdotal reports, the clinicians interviewed described how, even in the absence of formal declarations of crisis capacity, a variety of expected and unexpected forms of resource limitations severely compromised care and required that they make difficult allocation decisions at the bedside.
Although we provide care in a less intensive environment, the plan should be the same. Expanding the scope of institutional planning beyond crisis capacity may be helpful in supporting clinicians and addressing moral distress, promoting equity, and optimizing care as the pandemic evolves. Stay the course, stay strong, stay well, mask up, and stay tuned!