ITALY 5 WEEKS AGO – TOMORROW WESTPOINT. But will older people even get in?
By Greg Wilford in www.thetimes.co.uk
Doctors and other health professionals have been issued with a “clinical frailty scale” to identify “who may not benefit from critical care interventions”, the NHS has confirmed.
Infected people aged 65 or over will be given a points tally based on their age, frailty and underlying conditions. According to the system, if someone scores above eight points they should probably not be admitted to intensive care, according to the Financial Times.
Instead, they should be given “ward-based care” and a trial of non-invasive ventilation, the newspaper said. However, official guidance states that clinical discretion could be used to override the scoring system if a situation requires “special consideration”.
A frontline NHS consultant said: “The scoring system is just a guide. We make the judgment taking into account a lot of information about the current ‘nick’ of the patient — oxygenation, kidney function, heart rate, blood pressure — which all adds into the decision-making. If this was a bacterial pneumonia or a bad asthma attack, then that is treatable and you might send that older patient to intensive care.”
The NHS says the scale has not yet been validated for use with people under 65 or those with learning disabilities. It can currently be used by “any appropriately trained healthcare professional”, including doctors, nurses, healthcare assistants and therapists.
Any patient aged 71-75 will automatically score four points for their age and a likely three for their frailty, taking their total to seven, it was reported. Those with conditions such as dementia, high blood pressure or recent heart and lung disease will be given more points.
An NHS website outlining guidance on the scoring system states that it “is a reliable predictor of outcomes in the urgent care context”. It continues: “Like any decision support tool, it is not perfect and should not be used in isolation to direct clinical decision-making.
“It will sensitise you to the likely outcomes in groups of patients, but clinical decision-making with individual patients should be undertaken through a more holistic assessment, using the principles of shared decision-making.”
The scoring system is included in guidelines on critical care for adults with Covid-19 issued by the National Institute for Health and Care Excellence (Nice). It was originally developed at Dalhousie University in Halifax, Canada. The news emerged after NHS England wrote to all GPs asking them to contact vulnerable patients to ensure that plans for end-of-life decisions were in place.
Ruthe Isden, head of health and care at Age UK, said some elderly patients have felt unsettled and pressured to sign “Do not resuscitate” forms. “Clinicians are trying to do the right thing and these are very important conversations to have, but there’s no justification in doing them in a blanket way,” she said. “It is such a personal conversation and it’s being approached in a very impersonal way.”
Some intensive care wards are now approaching capacity, with about 5,000 Covid-19 cases presenting every day. The NHS and Nice declined to comment last night.