Standards of care in the Covid-19 crisis « Back to Blogs
Covid-19 has caused more than 2.9 million infections and more than 190 000 deaths.
It has placed enormous strain on healthcare professionals and healthcare systems around the world. Many healthcare systems are in a state of crisis. And many healthcare professionals have found themselves in the middle of this crisis — struggling with difficult clinical, ethical, and legal dilemmas.
What should healthcare professionals do? And where should they go for help?
The National Academies of Sciences, Engineering, and Medicine have recently published the results of a rapid expert consultation on crisis standards of care for the COVID-19 pandemic. (1) It outlines guiding principles and key elements of planning that should inform decisions when a health crisis means that usual standards of care cannot be adhered to. It covers clinical guidance — such as how to allocate resources that are limited but that could make a real difference to the survival of certain patients. Even though health services might be in crisis, healthcare professionals are still obliged to uphold core ethical principles — including those of “fairness, duty to care, duty to steward resources, transparency in decision making, consistency, proportionality, and accountability.” Care must also be evidence-based — although, at the start of an outbreak, there may not be a great deal of evidence on which to base decisions. However, the consultation paper is clear that “evidence-based care guidelines may emerge over the course of the pandemic” and that clinical practice should evolve in light of this.
However, this does represent a considerable challenge to healthcare professionals. The growth of new knowledge about Covid-19 has been unprecedented. Our own clinical decision support topic from BMJ Best Practice on Covid-19 already contains over four hundred references and over thirty guidelines. It is impossible for clinicians to learn all of this new evidence — so clinical decision support that works at the point of care becomes even more important. We are also providing BMJ Learning modules on Covid-19 and related diseases. Guidance on Covid-19 and related conditions from both resources are currently open access — with the express purpose of enabling “increased access, flexibility, and choice to the learner”. (2) We hope that it is helpful in this time of crisis.
But there is another vitally important piece of guidance in the consultation paper. The paper states that “healthcare planning must do everything possible never to need crisis standards of care”. Can all governments and healthcare leaders really state that they have done this? That they have strengthened their healthcare systems so that they are robust and have some spare capacity? That they acted quickly enough to the threat of a pandemic? That is a wider question and one that will need a public enquiry to answer.
- National Academies of Sciences, Engineering, and Medicine 2020. Rapid Expert
Consultation on Crisis Standards of Care for the COVID-19 Pandemic (March 28,
2020). Washington, DC: The National Academies Press.
Walsh K. Massive open online courses on health and medicine: will they be sustainable? J Med Internet Res. 2014 Aug 25;16(8):e197.
KW works for BMJ which produces e-learning and clinical decision support resources on Covid-19.