Prioritizing critical-care resources in response to COVID-19: lessons from the development of Thailand's Triage protocol

Abstract

As COVID-19 ravages the world, many countries are faced with the grim reality of not having enough critical-care resources to go around. Knowing what could be in store, the Thai Ministry of Public Health called for the creation of an explicit protocol to determine how these resources are to be rationed in the situation of demand exceeding supply. This paper shares the experience of developing triage criteria and a mechanism for prioritizing intensive care unit resources in a middle-income country with the potential to be applied to other low- and middle-income countries (LMICs) faced with a similar (if not more of a) challenge when responding to the global pandemic. To the best of our knowledge, this locally developed guideline would be among the first of its kind from an LMIC setting. In summary, the experience from the Thai protocol development highlights three important lessons. First, stakeholder consultation and public engagement are crucial steps to ensure the protocol reflects the priorities of society and to maintain public trust in the health system. Second, all bodies and actions proposed in the protocol must not conflict with existing laws to ensure smooth implementation and adherence by professionals. Last, all components of the protocol must be compatible with the local context including medical culture, physician–patient relationship, and religious and societal norms.

Ethical rationing of healthcare resources during COVID-19 outbreak: Review

“…A study conducted across European borders focussed to assess their allocation preferences revealed a majority opinion that they should be made available for supraregional patients and a need for a central institution to manage such resource allocation [15] . Stakeholder consultation and public engagement during protocol development for resource allocation will be helpful to avoid conflict and understand the priorities of society [16] . This would eventually help in smooth implementation and adherence by professionals as no ethical norms will be overlooked or ignored.…”

Communication transforms the impact of the COVID‐19 pandemic on children with cancer and their families

“… 4 , 13 , 14 , 36 The three domains—contributing factors, patient‐related impacts, central transformer—were consistently identified across all country income classifications, with the central transformer, communication , mentioned less often by participants in low‐income countries. This difference could be due to a bigger focus on allocation and mobilization of physical resources in resource‐limited settings 7 , 37 with less exploration of the utility of communication efforts. It is also possible the pandemic more greatly impacted patient care and communication in these settings, potentially increasing existing disparities in childhood cancer care.…”

How can health technology assessment support our response to public health emergencies?

“…In Thailand, for instance, HITAP developed a prioritization protocol in the event of shortages of critical care and intensive care units resulting from a sudden increase in the number of severe COVID-19 patients. With the extensive involvement of relevant stakeholders (including religious leaders, clinicians and ethicists) in the decision-making process, the overarching need to prioritize “maximizing total benefits for the society” was identified and agreed upon as the primary ethical principle guiding the decision-making for critical care resources [ 33 ]. These types of consensus-building across prioritization and decision-making processes are vital and must be transparently communicated to broader stakeholder groups such as the public through open lines of communication.…”