Providence St. Vincent pediatrics implementing crisis standards of care

Jennifer Burrows
Chief Executive
Providence St. Vincent Medical Center

As you know, along with health systems across Oregon and nationwide, Providence is seeing a high number of babies and young children with RSV, or respiratory syncytial virus, requiring hospitalization. In order to maximize the number of pediatric patients we can care for, the pediatric units at Providence St. Vincent Medical Center are moving into crisis standards of care. This will help us manage capacity to address the overwhelming demand for hospital services.

The Oregon Health Authority says that crisis standards of care are activated when patient care resources are severely limited, the number of patients presenting for care exceeds capacity, and there is no option to transfer patients to other acute or critical care facilities. Today, in the Portland metro region, we meet that criteria.

This step includes an interim crisis care tool from OHA to help hospitals make triage decisions and allocate scarce resources equitably. Thankfully, we are not at that point, and we are not making triage care decisions at this time. Instead, we are using the OHA guidance to maximize all of our resources, including staffing and nontraditional units of care for adolescents.

This declaration informs the community and the Oregon Health Authority of our current status. It also gives us the flexibility to adjust staffing plans in areas where this might be needed. For example, nurse ratios may change in critical or acute care units, patient care responsibilities might change from our registered nurses to our respiratory therapists, and other caregivers may be used to support assignments with more patients or increased acuity.

At this time, we are declaring crisis standards of care for the PICU, inpatient pediatrics and our neonatal ICU at Providence St. Vincent.  

We are working with our pediatric care teams and providers to ensure we are activating all resources to help us manage through this surge.

Continuum of care definitions

As described in the Oregon Health Authority’s Interim Crisis Care Tool, hospitals experience surge capacity during a disaster on a care continuum. The OHA uses standard definitions from the Institute of Medicine which describe three phases of capacity status: conventional, contingency and crisis:  

• Conventional capacity: Hospitals have the spaces, staff and supplies to meet usual daily needs for patient care.  
• Contingency capacity: Hospitals can temporarily adjust spaces and practices to make up for a shortage of spaces, staff and supplies.  
• Crisis capacity: Hospitals must significantly change standards of care because:   
  • Resources are severely limited.  
  • More patients need critical care than hospitals can supply.  
  • Moving patients to another critical care center is not an option.  

We will keep you updated as conditions change. Thank you for your dedication to our patients, families, and each other.