Coronavirus: Doctors given new guidelines on choosing which patients to treat in critical care

NHS staff face tragic choices if hospitals run out of intensive care beds or ventilators

Peter Stubley
Saturday 21 March 2020 19:14 GMT
Coronavirus: Harrowing footage from Italy hospital showing A+E overrun with coronavirus patients

New guidelines have been published to help doctors and nurses decide how to prioritise patients during the coronavirus pandemic.

The advice from the National Institute for Health and Care Excellence (Nice) was produced amid concerns that the NHS would be overwhelmed by the demand for intensive care beds and ventilators.

It follows reports from the worst-hit parts of Italy where older and sicker patients had to be rejected in favour of the younger and fitter.

The three new Nice guidelines, which have been drawn up within a week rather than the usual timescale of up to two years, cover patients needing critical care, kidney dialysis and cancer treatment.

They say all patients admitted to hospital should still be assessed as usual for frailty “irrespective of Covid-19 status”.

Decisions about admitting patients to critical care should consider how likely they are to recover, taking into account the likelihood of recovery “to an outcome that is acceptable to them”.

Doctors are advised to discuss possible “do not resuscitate” decisions with adults who are assessed as having increased frailty, such as those who need help with outside activities or are dependent for personal care.

The document says critical care treatment should be stopped “when it is no longer considered able to achieve the desired overall goals”, following a discussion with family, carers, the patient or an independent advocate.

For cancer patients, medics will need to balance the risks of the patient not being treated in the usual way against the risk of them becoming seriously ill through coronavirus due to a weakened immune system.

Alternative options mentioned in the guidance include offering treatment at different locations, taking longer breaks between treatments and delivering treatments in different forms.

Kidney dialysis patients suspected of having the virus could have their treatment delayed until their test results are known.

The guidelines also recommend making alternative transport arrangements if the normal provider refuses to transport patients confirmed to have Covid-19.

Professor Duncan Young, professor of intensive care medicine at the University of Oxford, said: ”Implicit in this guidance is that human resources – critical care team members - and physical resources – suitably equipped critical beds – will be extremely stretched in the coming weeks.”

Nice said it was making its guidance available online so other countries can see the approach the UK is taking to tackle the virus and care for patients in the NHS.

Further updated guidelines are expected in the coming weeks on symptom management, radiotherapy patients, and those with rheumatoid arthritis.

Nice is also reviewing whether some drugs, such as ibuprofen or blood pressure medication, will aggravate the condition of patients with coronavirus.

Additional reporting by Press Association

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