PT  - JOURNAL ARTICLE
AU  - Tim Cook
AU  - Kim Gupta
AU  - Chris Dyer
AU  - Robin Fackrell
AU  - Sarah Wexler
AU  - Heather Boyes
AU  - Ben Colleypriest
AU  - Richard Graham
AU  - Helen Meehan
AU  - Sarah Merritt
AU  - Derek Robinson
AU  - Bernie Marden
TI  - Development of a structured process for fair allocation of critical care resources in the setting of insufficient capacity: a discussion paper
AID  - 10.1136/medethics-2020-106771
DP  - 2020 Nov 20
TA  - Journal of Medical Ethics
PG  - medethics-2020-106771
4099  - http://jme.bmj.com/content/early/2020/11/20/medethics-2020-106771.short
4100  - http://jme.bmj.com/content/early/2020/11/20/medethics-2020-106771.full
AB  - Early in the COVID-19 pandemic there was widespread concern that healthcare systems would be overwhelmed, and specifically, that there would be insufficient critical care capacity in terms of beds, ventilators or staff to care for patients. In the UK, this was avoided by a threefold approach involving widespread, rapid expansion of critical care capacity, reduction of healthcare demand from non-COVID-19 sources by temporarily pausing much of normal healthcare delivery, and by governmental and societal responses that reduced demand through national lockdown. Despite high-level documents designed to help manage limited critical care capacity, none provided sufficient operational direction to enable use at the bedside in situations requiring triage. We present and describe the development of a structured process for fair allocation of critical care resources in the setting of insufficient capacity. The document combines a wide variety of factors known to impact on outcome from critical illness, integrated with broad-based clinical judgement to enable structured, explicit, transparent decision-making founded on robust ethical principles. It aims to improve communication and allocate resources fairly, while avoiding triage decisions based on a single disease, comorbidity, patient age or degree of frailty. It is designed to support and document decision-making. The document has not been needed to date, nor adopted as hospital policy. However, as the pandemic evolves, the resumption of necessary non-COVID-19 healthcare and economic activity mean capacity issues and the potential need for triage may yet return. The document is presented as a starting point for stakeholder feedback and discussion.