Ballad’s COVID-19 worst-case crisis plan includes ‘triage team’ to determine who gets life-saving care

Local Coronavirus Coverage

JOHNSON CITY, Tenn. (WJHL) – Ballad Health is preparing for a worst-case COVID-19 scenario: what to do if the number of patients needing specific types of care exceeds the resources needed to provide that care.

The head of the region’s only hospital system says teams are working to make sure that doesn’t happen while developing and communicating a plan in case it does.

“It’s something we hope doesn’t happen, but we’re being very transparent about it,” said Alan Levine, Ballad Health President and CEO.

That confirmation comes as Ballad Health reports it’s currently treating almost 300 COVID-19 patients and expecting that number to increase to 400 in the next few days.

So Ballad staff members currently are being trained on protocol if critical resources become scarce because of a surge in sick patients, including people with COVID-19, Levine said.

“We’re going to do everything we can for every patient we have,” Levine said. But when you don’t have a resource, you have to make that decision. We don’t want it to be a guessing game.”

According to the latest plan, if resources like ventilators, supplemental oxygen, BiPAP and CPAP machines, IV pumps and lifesaving medications become scarce, a letter will be given to patients being admitted to Ballad Hospitals serving them notice that because hospitals have become overwhelmed by COVID-19 patients, those potentially lifesaving resources might not be available for everyone.

The scarce resource plan is not currently being deployed, and the “Scarce Resource Allocation Patient Notification Letter” is not currently being given to patients, Ballad Health says.

“For instance, if we determine we are out of ventilators and we can’t get more ventilators, then you have to decide who gets the ventilator,” Levine said.

That decision, according to the patient letter, would be made by what’s called a “triage team” compromised of clinical and administrative personnel.


That triage team would assign patients a priority color code. The letter states that code would designate “the order in which you will receive access to a scarce resource based on your clinical condition.”

After the triage team assesses factors such as age and medical history, those most likely to survive treatment would get priority, and the letter states, “In the case of a tie between adults and children, the child would receive the allocation.”

Levine said the process would be ethics-driven with oversight by the Ballad Health Clinical Council which adopted the “guidelines for the allocation of scarce resources under crisis standards of care” with the approval of the Ballad Health Board of Directors.

“If you dedicate the resource to someone who is less likely to survive then you might lose someone who could have lived,” Levine said. “So what drives the decision is – who is the most critical and who is the most likely to benefit from it.”

The “scarce resource allocation patient notification letter” also spells out what happens after scarce resources are allocated.

“If you are allocated a scarce resource, 48 and 120 hours after the initial decision your priority score will be recalculated, and your progress assessed,” the letter states. “If you have shown no improvement, or your condition has worsened, your access to the lifesaving scarce resource may be withdrawn and reallocated to a patient more likely to survive discharge from the hospital and you and your family will be referred to Ballad Health’s palliative care providers.”

Levine said the patient’s physicians in consultation with family would be the patient’s advocate and would have the ability to appeal decisions made by the triage team.

While Levine said hospitals in other parts of the country already are using resource allocation plans, he would not speculate on if or when it could happen at Ballad Health.

“We think it’s more responsible to be proactive about this so that if it does come to pass, we’re not knee-jerking,” he said. “We’re making good decisions based on evidence, best practices, and what’s in the best interest of the patients.”

Ballad recently paused all elective surgeries to free up resources to care for critically ill patients, and Ballad just purchased 50 new ventilators, Levine confirmed.

“The point is when you get the place where you can’t do that anymore that’s when you have to start making those hard decisions,” he said.

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