Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis

Abstract

The COVID-19 pandemic may require rationing of various medical resources if demand exceeds supply. Theoretical frameworks for resource allocation have provided much needed ethical guidance but hospitals still need to address objective practicalities and legal vetting to operationalize scarce resource allocation schemata. To develop operational scarce resource allocation processes for public health catastrophes, including the COVID-19 pandemic, five health systems in Maryland formed a consortium – with diverse expertise and representation – representing more than half of all hospitals in the state. Our efforts built on a prior statewide community engagement process, which determined the values and moral reference points of citizens and healthcare professionals regarding the allocation of ventilators during a public health catastrophe. Through a partnership of health systems, we developed a scarce resource allocation framework informed by citizens’ values and by general expert consensus. Allocation schema for mechanical ventilators, intensive care unit resources, blood components, novel therapeutics, extracorporeal membrane oxygenation, and renal replacement therapies were developed. Creating operational algorithms for each resource posed unique challenges; each resource’s varying nature and underlying data on benefit prevented any single algorithm from being universally applicable. The development of scarce resource allocation processes must be iterative, legally vetted, and tested. We offer our processes to assist other regions that may be faced with the challenge of rationing healthcare resources during public health catastrophes.

Functionality of Scarce Healthcare Resource Triage Teams During the COVID-19 Pandemic: A Multi-Institutional Simulation Study

“…The triage team constitutes only one component of a broader process of scarce resource allocation and processes upstream and downstream of triage team decisions that will also impact feasibility, effectiveness, and fairness of the system overall (21). Our prior work supports the efficiency of collecting patient information items from an institutional electronic health record (22), but local planning within each institution for how to collect this information will be important to support operationalizability.…”

Evaluation of the Neonatal Sequential Organ Failure Assessment and Mortality Risk in Neonates with Respiratory Distress Syndrome: A Retrospective Cohort Study

“…As an objective measure of clinical course, nSOFA score has a potential utility both as a proxy variable for disease severity and as a risk assessment indicator for short-and long-term clinical endpoints [9]. In this study, the nSOFA score showed good correlation in most cases and its ndings will be useful for clinicians and researchers who need tools to objectively measure the risk of death, as well as for healthcare leaders and policy makers who develop resource allocation protocols for critically ill patients [24].…”

The effect of the Covid-19 outbreak on the management of acute appendicitis: A retrospective comparative cohort study

“…Hansson et al [27] reported that AA patients with CRP <60 g/L, WBC <12 × 10 9 /L, and age <60 years could be treated conservatively with 89% accuracy [21]. The management algorithms of emergency disease have changed during Cov19 [28,29]. The management of acute appendicitis involves, if possible, conservative treatment as an outpatient, short hospitalization, operation with an open technique and under regional anesthesia [16].…”