The Royal College of Physicians, Royal College of Emergency Medicine, British Medical Association, Faculty of Intensive Care Medicine and Intensive Care Society have welcomed guidance published by NICE (National Institute for Health and Care Excellence) on critical care in the context of COVID-19.
Advanced care planning for all people is essential at this time and this needs to happen as early as possible, preferably before someone is admitted to hospital. We need to understand what a person wants with respect to treatments and also ensure that everyone understands the benefits or not of treatments we currently have for respiratory failure.
Such decision making is normal practice in the healthcare system but perhaps has not been as widely adopted as it should have been. Doctors and their teams are very used to shared-decision making both between themselves and patients as well as between teams. Good communication is especially important at this time as it always is to ensure patient autonomy is respected.
COVID-19 is likely to result in a shortage of critical care beds in a particular hospital. Working in regions to share resource and having clear escalation plans set by NHS England will be necessary.
Tough decisions may need to be made when the shortage is at its worst. We will work together over the next week or so to ensure that clinicians are supported in their decision making both by the hospitals they work in and the wider system. This will be clinical and ethical guidance.
