Billings Clinic preparing for Crisis Standards of Care

With new COVID-19 cases and related hospitalizations spiking, Billings Clinic stands in full support of the updated Crisis Standards of Care recently announced by the Montana Department of Public Health and Human Services (DPHHS). Although not yet in place at Billings Clinic, implementation of these measures may be needed as early as this week if COVID-19 volumes don’t slow down.

The drastic, quick and ongoing increase in hospitalizations and Emergency Department visits due to COVID-19 is putting immense strain on Billings Clinic and health care organizations across the region. While the hope is to not have to implement these Crisis Standard of Care measures – which provide guidance on how to allocate limited medical supplies, space and staff in the event of scarcity of resources due to the COVID-19 pandemic – it is critically important that health care organizations are ready to do so if the need arises.

Billings Clinic is already using contingency standards, which are different from normal processes, but able to achieve sufficiency of care, and is moving toward Crisis Standards of Care. We anticipate that crisis care will occur in our region and use of this guidance will be necessary. The organization is preparing to quickly move into crisis care and will only stay in that stage as long as needed. It is possible to move in and out of crisis care multiple times based on the situation and needs.

“While the current increase in numbers is moving us closer to having to implement these standards, Billings Clinic is constantly and diligently working to avoid having to do so,” said Scott Ellner, DO, Billings Clinic CEO. “The numbers across our region are overwhelming health care facilities and staff. We are doing everything we can to take care of everyone who needs us, and we will continue to find ways to do that.”

To address high volumes and capacity constraints, Billings Clinic is:

• expanding its COVID-19 testing and monoclonal antibody treatment capabilities to provide more outpatient services that may help keep people out of the hospital.
• creating additional temporary triage space in or near the Emergency Department to manage, diagnose and treat the ongoing extremely high number of patients seeking care.
• continuing to work daily with numerous agencies and organizations across the state, region and country to bring in additional temporary staff and National Guard resources to help ease the burden on care teams.
• opening additional overflow space for more patients.
• dedicating additional units to care only for COVID-19-positive patients.

Crisis care occurs when it is no longer possible to deliver the normal standard of care to all persons in need. This is not a choice, but occurs when health care resources are overwhelmed by a disaster or emergency. The goal of medical care in this situation shifts from a focus on individual patients to managing resources in a manner that results in the best possible health outcomes for the community as a whole. This can include decisions about how to save the most lives by allocating or reallocating equipment such as ventilators, spaces such as ICU beds, or decisions about when resuscitation efforts are appropriate.

The transition into crisis care can occur rapidly and may impact care of many conditions, not just persons ill with COVID-19. These standards are guided by foundational medical ethics principles and were created by a broad-based collaborative effort across Montana including representatives of disadvantaged and disabled persons. They have been endorsed by Governor Gianforte and the Montana Department of Public Health and Human Services. They provide a framework to both help prevent crisis care and to ensure that the difficult decisions made under crisis care are fair, consistent, equitable, transparent, and do not discriminate.

The Crisis Care Guidance documents can be found on the DPHHS website under Resources from DPHHS Partners. Please scroll to the bottom of the page in the drop-down menu section.