Ballad Scarce Resource Allocation Patient Notification Letter

Scarce Resource Allocation Patient
Notification Letter
Page 1 of 2 Patient Identification
Patient Identification Number: ___________________________

As a result of the COVID-19 pandemic, the Ballad Health board of directors declared a state of emergency for the health system
on XX/XX/XXXX. This action recognizes the threat to the public’s health presented by the pandemic and the stress and strain
that the pandemic places on the delivery of health care within the region and within Ballad Health’s hospitals, outpatient
services, physician clinics, skilled nursing facilities and other health care facilities.
An important part of the emergency response has been to manage a national shortage of items necessary to protect Ballad Health
staff and patients, such as PPE as well as equipment necessary to provide lifesaving treatment to patients admitted to the hospital
for all causes.
The number of COVID-19 cases in Ballad Health’s service area has led to a greater number of hospital admissions than normal. In
preparation for the possibility that Ballad Health will not have enough beds, supplies (including medications), or equipment
necessary to provide lifesaving treatment to everyone admitted to the hospital who needs it, the Ballad Health Clinical Council –
comprised of physicians representing each hospital in the Ballad Health system - has adopted guidelines for the allocation of scarce
resources under crisis standards of care.
The goal of these specific guidelines is maximizing the opportunities for patients to access meaningful lifesaving treatment during
a public health crisis.
Under crisis standards of care, physicians may not be able to optimize the care provided to each patient because of scarcity of
certain resources. While this policy may result in a lifesaving resource not being allocated to, or potentially withdrawn from, an
individual patient, Ballad Health, its team members, and its medical staff continue to have the duty to provide care for everyone to
the best of our ability, including palliative care. These guidelines are designed to:
1. Create meaningful access to lifesaving treatment for all patients. All patients who are eligible for ICU, ventilator and other
services during ordinary circumstances remain eligible, and there are no exclusion criteria based on age, disabilities, or
other factors. All patients are eligible to receive access to scarce resources and are prioritized based on the potential
clinical benefit from those resources;
2. Ensure that all patients receive individualized assessments by clinicians, based on the best available objective medical
evidence, and that each patient can expect their attending physician and bedside care team to advocate on their behalf;
3. Ensure that no one is denied care based on stereotypes, race, ethnicity, gender, sexual orientation, gender identify,
religious beliefs, socioeconomic standing, citizenship, immigration status, ability to pay, or other judgements of social worth
or quality of life.
Because you are being admitted to the hospital during a period where the system may find it necessary to implement
crisis standards of care, you should be aware that there is a chance, however unlikely, that regardless of your reason for
admission to the hospital, certain resources may not exist to provide you with live-saving treatment if you become critically
ill because the health system has become overwhelmed with COVID-19 admissions.
Lifesaving equipment which may be limited under these guidelines, includes, but is not limited to ventilators, supplemental oxygen,
BiPAP and CPAP machines, IV pumps and lifesaving medications.
Decisions regarding which patients are allocated scarce resources are made based on objective clinical criterial agreed to by the
medical staffs of Ballad Health. In each case, your attending physician and your bedside care team is your advocate. Should
you need it, the decision to allocate you a scarce resource is made by a triage team (team consists of both clinical and
administrative personnel) that receives information on your clinical condition and has access to the inventory of scarce resources
across Ballad Health.
Form No: MS-7762 Revised: 8/23/2021 FRONT

Scarce Resource Allocation Patient
Notification Letter
Page 2 of 2 Patient Identification
Using this information, the triage team assigns a priority color code designating the order in which you will receive access to a
scarce resource based on your clinical condition. In the case where you and other patients have the same priority, and each need
access to the same lifesaving scarce resource, a random allocation method will be used to make the assignment. In the case of a
tie between adults (18 years+) and children, the child will receive the allocation.
Your access to a lifesaving scarce resource within Ballad Health is not limited to the hospital you are admitted to. Ballad Health
may move a scarce resource to you or transfer you to a hospital where that resource is located. You reserve your right to approve
your physician’s recommended course of treatment and to refuse care offered to you.
Should you need access to a potentially scarce resource under crisis standards of care, you and your authorized family members
should expect to be kept informed by your physician and your bedside care team. This includes being told when an allocation
decision has been made and the criteria leading to that decision. You may request that this decision is reviewed to ensure y our
clinical information priority score was appropriately calculated.
If at any time you are denied access, you will continue to have opportunities to gain access to a lifesaving scarce resource as they
become available. You and your family will also receive consultation from Ballad Health’s palliative care providers.
If you are allocated a scarce resource, forty-eight and 120 hours after the initial decision your priority score will be recalculated, and
your progress assessed. 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.
By signing this document, you acknowledge that you have read and/or had this information read to you. You have had the
opportunity to ask questions and had your questions answered. If at any time during your stay, you have questions about
the allocation of scarce resources during Ballad Health’s state of emergency, please ask a member of your care team.
_________________________________________________________________ _____________ ____________

Patient Signature Date Time
Form No: MS-7762 Revised: 8/23/2021 BACK

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Scarce Resource Allocation Patient

Patient Identification Number: ___________________________

Form No: MS-7762 Revised: 8/23/2021 FRONT

___________________________________________________________ _ ______

Form No: MS-7762 Revised: 8/23/2021 BACK

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