A catalogue of tools and variables from crisis and routine care to support decision-making about allocation of intensive care beds and ventilator treatment during pandemics: Scoping review

Cardona, Magnolia; Dobler, Claudia C.; Koreshe, Eyza; Heyland, Daren K.; Nguyen, Rebecca; Sim, Joan P. Y.; Clark, Justin; Psirides, Alex

doi:10.1016/j.jcrc.2021.08.001

Cited by 12 publications

(17 citation statements)

References 104 publications

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“…In Italy, the public did not agree with the pre-set age limit of a clinical assessment tool and suggested that it was less arbitrary to consider the patient's age globally [ 53 ]. It is noteworthy that some clinical tools take the patient’s age as one of their variables [ 25 , 95 ]. This could be explained by the fact that the biological age of a patient influences the response to intensive therapy.…”

Section: Discussionmentioning

confidence: 99%

“…For example, they consider the urgency and severity of the patient's illness, and the vital prognosis such as acute and chronic comorbidities or the probability of death for poor prognosis diseases or degenerative diseases, among other aspects. These primary prioritization criteria can be based on both standardized clinical scales or scores, without missing the clinical judgment of the physicians or the triage team [ 23 – 25 ]. In contrast, criteria considered tiebreakers or supplementary or non-clinical criteria, have been developed for secondary use in ICU admission decisions.…”

Section: Introductionmentioning

confidence: 99%

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Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review

Ramirez

Farmer

Bouthillier

2023

Discov Health Systems

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Background To reduce the arbitrariness in the allocation of rare resources in intensive care units (ICU) in the context of the pandemic, tiebreakers were considered in some COVID-19 triage algorithms. They were also contemplated to facilitate the tragic decisions of healthcare workers when faced with two patients with similar prognosis and only one ICU bed available. Little is known about the public's perspective on tiebreakers. Objectives To consolidate the available scientific literature on public consultations, particularly on tiebreakers and their underlying values. Also, to obtain an overview of the key arguments presented by the participating public and to identify potential gaps related to this topic. Methods The steps described by Arksey and O’Malley was the preferred method to our approach. Seven electronic databases were searched from January 2020 to April 2022, using keywords for each database: PubMed, Medline, EMBASE, Web of Science, PsycINFO, EBM reviews, CINAHL complete. We also searched in Google and Google Scholar, and in the references of the articles found. Our analysis was mainly qualitative. A thematic analysis was performed to consider the public’s perspectives on tiebreakers and their underlying values, according to these studies. Results Of 477 publications found, 20 were selected. They carried out public consultations through various methods: surveys (80%), interviews (20%), deliberative processes (15%) and others (5%) in various countries: Australia, Brazil, Canada, China, France, Germany, India, Iran, Italy, Japan, Korea, Netherlands, Portugal, Spain, Switzerland, Thailand, United Kingdom, and United States. Five themes emerged from our analysis. The public favored the life cycle (50%) and absolute age (45%) as a tiebreaker. Other values considered important were reciprocity, solidarity, equality, instrumental value, patient merit, efficiency, and stewardship. Among the new findings were a preference for patient nationality and those affected by COVID-19. Conclusions There is a preference for favoring younger patients over older patients when there is a tie between similar patients, with a slight tendency to favor intergenerational equity. Variability was found in the public’s perspectives on tiebreakers and their values. This variability was related to socio-cultural and religious factors. More studies are needed to understand the public's perspective on tiebreakers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review

Ramirez

Farmer

Bouthillier

2023

Discov Health Systems

View full text Add to dashboard Cite

show abstract

“…In Italy, the public did not agree with the pre-set age limit of a clinical assessment tool and suggested that it was less arbitrary to consider the patient's age globally [53]. It is noteworthy that some clinical tools take the patient's age as one of their variables [25,95]. This could be explained by the fact that the biological age of a patient in uences the response to intensive therapy.…”

Section: Absolute Agementioning

confidence: 99%

“…For example, they consider the urgency and severity of the patient's illness, and the vital prognosis such as acute and chronic comorbidities or the probability of death for poor prognosis diseases or degenerative diseases, among other aspects. These primary prioritization criteria can be based on both standardized clinical scales or scores, without missing the clinical judgment of the physicians or the triage team [23,24,25]. In contrast, criteria considered tiebreakers or supplementary or non-clinical criteria, have been developed for secondary use in ICU admission decisions.…”

mentioning

confidence: 99%

Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review

Ramirez

Farmer

Bouthillier

2023

Preprint

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Background To reduce the arbitrariness in the allocation of rare resources in intensive care units (ICU) in the context of the pandemic, tiebreakers were considered in some COVID-19 triage algorithms. They were also contemplated to facilitate the tragic decisions of healthcare workers when faced with two patients with similar prognosis and only one ICU bed available. Little is known about the public's perspective on tiebreakers. Objectives To consolidate the available scientific literature on public consultations, particularly on tiebreakers and their underlying values. Also, to obtain an overview of the key arguments presented by the participating public and to identify potential gaps related to this topic. Methods The steps described by Arksey & O'Malley was the preferred method to our approach. Seven electronic databases were searched from January 2020 to April 2022, using keywords for each database: PubMed, Medline, EMBASE, Web of Science, PsycINFO, EBM reviews, CINAHL complete. We also searched in Google and Google Scholar, and in the references of the articles found. Our analysis was mainly qualitative. A thematic analysis was performed to consider the public's perspectives on tiebreakers and their underlying values, according to these studies. Results Of 477 publications found, 20 were selected. They carried out public consultations through various methods: surveys (80%), interviews (20%), deliberative processes (15%) and others (5%) in various countries: Australia, Brazil, Canada, China, France, Germany, India, Iran, Italy, Japan, Korea, Netherlands, Portugal, Spain, Switzerland, Thailand, United Kingdom, and United States. Five themes emerged from our analysis. The public favored the life cycle (50%) and absolute age (45%) as a tiebreaker. Other values considered important were reciprocity, solidarity, equality, instrumental value, patient merit, efficiency, and stewardship. Among the new findings were a preference for patient nationality and those affected by COVID-19. Conclusions There is a preference for favoring younger patients over older patients when there is a tie between similar patients, with a slight tendency to favor intergenerational equity. Variability was found in the public's perspectives on tiebreakers and their values. This variability was related to socio-cultural and religious factors. More studies are needed to understand the public's perspective on tiebreakers.

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“…There are research originating from the medical field especially the critical care medicine regarding ventilator prioritization however not much of them seems to implement IT principles, especially DSS to support the decision-making phase. Cardona et al [2] and Piscitello et al [3] mostly reviewed algorithms and strategies in 20 countries and USA respectively. In terms of the methods applied in the research, Mukharir and Wardoyo [4] designed a similar DSS with different research objective, and a little different interpolation where the said research also uses profile matching to handle user preference.…”

Section: Introductionmentioning

confidence: 99%

Decision Support System to Prioritize Ventilators for COVID-19 Patients using AHP, Interpolation, and SAW

Prasetyo¹,

Wardoyo²

2022

Indonesian J. Comput. Cybern. Syst.

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Ventilator shortages is a common problem faced by hospitals during the COVID-19 pandemic era. Healthcare workers are forced to make choices because of how big the difference between resources and lives needing it. This issue rarely comes, because normally every patient has the same rights to receive treatment and resources, but it becomes a clear problem when there are barely enough resources. Therefore, a prioritization mechanism that can objectively decide the allocation must be made to achieve the best outcome.A decision support system is a system that can support humans using data as decision makers to help them decide semi-structured/unstructured problems. The goal of this research is to create a DSS to prioritize patients who need a ventilator by incorporating two different methods, which are AHP, Interpolation, and SAW. It is hoped that the result of the research can be used to rank patients based on predetermined criterias and policy.

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A catalogue of tools and variables from crisis and routine care to support decision-making about allocation of intensive care beds and ventilator treatment during pandemics: Scoping review

Cited by 12 publications

References 104 publications

Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review

Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review

Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review

Decision Support System to Prioritize Ventilators for COVID-19 Patients using AHP, Interpolation, and SAW

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