AMA: Planning for COVID-19 patient surges requires doctors’ input
Sunday, March 15, 2020
By: Kevin B. O'Reilly
American Medical Association
Hospitals and physician practices across the country are planning for how to deal with the stress on the U.S. health system posed by anticipated surges of patients needing care for COVID-19 infections. That decision-making process requires physicians’ input to ensure that individual patients’ health needs are properly considered.
The World Health Organization reports more than 140,000 confirmed cases of COVID-19—the disease caused by SARS-CoV-2—and more than 5,000 deaths globally. The AMA and the Centers for Disease Control and Prevention (CDC) are closely monitoring the COVID-19 global pandemic. Learn more at the AMA COVID-19 resource center and consult the AMA’s physician guide to COVID-19.
Several major stakeholders in medicine are rightly encouraging health systems and physicians to plan for volume surge related to this progressively severe threat, including prioritizing and reevaluating the timing of elective surgeries and procedures. The pressure of such surges will continue to evolve and vary from community to community based on each locale’s current status related to COVID-19 disease burden.
The American College of Surgeons has issued advice on how to manage elective surgical procedures. Among other things, the ACS recommends that each hospital, health system and surgeon should:
Thoughtfully review all scheduled elective procedures with a plan to minimize, postpone or cancel electively scheduled operations, endoscopies, or other invasive procedures until we have passed the predicted inflection point in the exposure graph and can be confident that our health care infrastructure can support a potentially rapid and overwhelming uptick in critical patient care needs.
Immediately minimize use of essential items needed to care for patients, including but not limited to, ICU beds, personal protective equipment, terminal cleaning supplies and ventilators. There are many asymptomatic patients who are, nevertheless, shedding virus and are unwittingly exposing other inpatients, outpatients and health professionals to the risk of contracting COVID-19.
Why physician input is essential
Doctors should take part in making these judgments based on the needs and circumstances of individual patients. As professionals dedicated to protecting the interests of their patients, physicians have a responsibility to contribute their expertise to developing allocation policies that are fair and safeguard the welfare of patients.
The AMA Code of Medical Ethics offers detailed advice to physicians on how to approach the allocation of limited health care resources. Among other things, it covers which criteria to consider, setting care priorities and the importance of transparency.
The CDC has contacted surgeons who practice in hospitals in geographic COVID-19 hot zones to advise them on how to prepare. The agency’s public health experts also have issued interim guidance for health care facilities’ preparing for community transmission of COVID-19 in the U.S. That includes advice for outpatient practices.