Crisis Care Continuum

California is experiencing an unprecedented and severe surge in COVID-19 cases, and staffing and other resources are becoming strained at hospitals. CDPH is outlining resources and expectations for all hospitals so that together California's health care delivery system achieves the following four goals:

Hospitals are able to remain in conventional or contingent care as long as possible
All Hospitals in a region work together, along with County partners, to support each hospital to remain in contingent care as long as possible during the surge
Hospitals have prepared plans for crisis care, rooted in equity, fairness and transparency, if needed and as a last resort
The public has clear and transparent information about the crisis care continuum and Hospitals' approach to crisis care during this surge

What is the Crisis Care Continuum?

Stakeholder Input on California's Crisis Care Continuum Guidelines

State Guidelines announced in June informed by various stakeholders including Hospitals, Health Systems, Local Health Jurisdictions, Emergency Services Managers, Aging and Disability Advocates
Advisory Group formed including Doctors, Medical Ethicists, and Aging, Disability, and Health Equity Experts
Also informed by:

Existing state and national guidelines
California Health Systems' draft guidelines
Existing recent medical literature

Current Status of Crisis Care Continuum

Based on the severity of the surge and on facility data, California has the working understanding that all hospitals are currently implementing some elements of contingency care, as of late December. Technical assistance is being provided by the State to hospitals at the individual and regional level, in partnership with County leaders. If a hospital does enter crisis care mode, it is required to notify the State and local public health jurisdiction, and the local public health jurisdiction will inform the public.

As a hospital approaches or enters crisis care, there are many ways a county and the state get notice: request for additional staffing, request for mutual aid, notice per an All Facilities Letter, and site visits. The response is to immediately mobilize regional and state resources to prevent crisis care or return the hospital to contingency care. Counties with hospitals nearer the crisis care end of continuum include: Los Angeles, Riverside, and San Bernardino.

Hospital Surge Order

As of February 5, 2021, CDPH rescinded its Hospital Surge Public Health Order. The Hospital Surge Order was put into place on January 5, 2021, as an emergency measure to address an urgent statewide crisis in ICU capacity that was caused by unprecedented exponential community transmission combined with scarce hospital resources in equipment, space, and staffing. The Order served to spread the COVID burden across hospitals and ensure that all patients were receiving a high quality of care to prevent loss of life. Current data reflecting declining cases, hospitalizations, and transmission rates indicates the burden on hospitals has been decreased, thus the Order was rescinded.