RT Journal Article
SR Electronic
T1 Development of a structured process for fair allocation of critical care resources in the setting of insufficient capacity: a discussion paper
JF Journal of Medical Ethics
JO J Med Ethics
FD BMJ Publishing Group Ltd and Institute of Medical Ethics
SP medethics-2020-106771
DO 10.1136/medethics-2020-106771
A1 Tim Cook
A1 Kim Gupta
A1 Chris Dyer
A1 Robin Fackrell
A1 Sarah Wexler
A1 Heather Boyes
A1 Ben Colleypriest
A1 Richard Graham
A1 Helen Meehan
A1 Sarah Merritt
A1 Derek Robinson
A1 Bernie Marden
YR 2020
UL http://jme.bmj.com/content/early/2020/11/20/medethics-2020-106771.abstract
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.