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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:

  1. Hospitals are able to remain in conventional or contingent care as long as possible

  2. 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

  3. Hospitals have prepared plans for crisis care, rooted in equity, fairness and transparency, if needed and as a last resort

  4. 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?

Crisis Care Continuum Summary

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

CDPH updated the Hospital Surge Public Health Order to clarify when hospitals must make notifications to state and local authorities on January 15. The order requires some non-essential and non-life-threatening surgeries to be delayed in counties with 10% or less of ICU capacity under the Regional Stay at Home Order, where the regional ICU capacity is at 0%. Examples of procedures that may be delayed include carpal tunnel release and non-urgent spine surgeries. Surgeries for patients who have serious and urgent medical conditions will continue. Examples of procedures that will continue include serious cancer removal and necessary heart surgeries. The order requires hospitals statewide to accept patient transfers from facilities that have implemented contingency or crisis care guidelines as long as those transfers can be done capably and safely. On December 28, 2020 CDPH provided guidance to health care facilities on implementing the Crisis Care Continuum Guidelines issued in June 2020.

Counties Currently Impacted by the Hospital Surge Order:
San Joaquin Valley: Fresno, Kern, Kings, Madera, Merced, San Benito, San Joaquin, Stanislaus, and Tulare
Southern California: Imperial, Los Angeles, Orange, Riverside, San Bernardino, San Diego, Santa Barbara, and Ventura

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Policy Guidance

Training Resources for Health Care Workforce

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