Johns Hopkins University: Howard County General Hospital Activates Crisis Standards of Care

While communities across the country grapple with the recent surge in COVID-19 cases, the pandemic continues to critically stress staffing and resources at hospitals and health care facilities, including the six hospitals within the Johns Hopkins Health System. As a result, today Johns Hopkins Health System and Howard County General Hospital leaders announced that the hospital will implement Crisis Standards of Care (CSC) protocols. This is the second hospital in the Johns Hopkins Health System to implement CSC. On December 29, Johns Hopkins Bayview Medical Center (JHBMC) transitioned to CSC.

“These are decisions that are not taken lightly,” says Kevin Sowers, president of the Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine. “For Howard County General Hospital, we have unfortunately seen its census of patients with COVID-19 and non-COVID-19 clinical needs spike dramatically in recent days. Working closely with the Johns Hopkins Medicine Unified Command Center staff, we have agreed that moving to CSC is the right decision.”

Since mid-December, Howard County General Hospital saw a 411% increase in patients hospitalized with COVID-19. JHBMC had seen a 360% increase in hospitalized patients with COVID-19 last week.

The CSC concept was developed by the Institute of Medicine — now known as the National Academy of Medicine — at the request of the Department of Health and Human Services (HHS) following Hurricane Katrina. This was done to provide a standard-of-care framework that would apply during disaster situations. Johns Hopkins Medicine has worked with the University of Maryland Medical System to standardize the process for activating Crisis Standards of Care.

To meet the growing demand for the care and safety of patients with COVID-19 while caring for patients with other medical needs, Johns Hopkins Health System hospitals have already opened additional treatment spaces for patients with COVID-19, rescheduled elective surgical procedures and redeployed staff to ensure that patients with COVID-19 and those dealing with other medical conditions are receiving safe, high-quality care.

Changes under CSC protocols will allow additional flexibility in how we:

Advance different clinical care models
Further modify elective surgical schedules
Simplify documentation requirements
Redeploy clinical and nonclinical staff
Improve patient flow through measures such as early discharges, when safe and appropriate
“Our continued commitment to providing safe, high-quality care for all our patients and the Howard County community remains at the forefront of everything we do,” said Shafeeq Ahmed, M.D., president of Howard County General Hospital. “The CSC protocols enable the necessary flexibility in our operations to continue to provide that care with the limited resources and staffing we, and so many others in health care, are experiencing.”

The CSC protocols for Howard County General Hospital are effective as of Jan. 4. Johns Hopkins Health System will continue to monitor patient census and staffing levels at the hospital closely — on a daily basis — and will reevaluate crisis level protocols accordingly.

Johns Hopkins Health System notified the Maryland health secretary and the Office of Health Care Quality in the Maryland Department of Health about this situation and submitted supporting documentation, as required under Governor Hogan’s directive. The Centers for Medicare and Medicaid Services will be contacted through the appropriate channels.

Johns Hopkins Medicine leadership remains in close contact with federal, state and community leaders, and continues to collaborate with health care partners and peers, including the University of Maryland Medical System, to ensure consistency and alignment in care protocols.