Table 1

Appropriate strategies for maximising aggregate benefit of a limited resource differ by the type of resource scarcity

Type of resource limitationStrategy for optimising aggregate population benefitMitigation or contingency capacity strategyCrisis capacity strategy
Life-supportive intensive care interventionPrioritise those patients most likely to survive.Limit non-emergent surgical procedures that may require postoperative intensive care unit stay. Expand use of non-invasive ventilation (eg, Bi-level Positive Airway Pressure [BiPAP] and high flow nasal canula).Enact an explicit, standardised, and transparent triage protocol to prioritise patients most likely to survive to receive scarce life-supportive treatments (eg, mechanical ventilation) and withhold these treatments from patients who are least likely to survive even were they to recieve this care.
Staff time and energyPrioritise the worst-off.Expedite hospital discharge for patients who are no longer in need of acute care.Restrict access to acute care services and hospital admission for defined cohorts of patients at relatively low risk of poor outcomes if this care were to be withheld.
Prioritise high-value treatments and staff interventions.Restrict clinical tasks that require intensive staff efforts, but for which the near-term patient benefit is negligible (eg, components of medical record documentation intended only for medical billing).Universally restrict selected treatments and staff interventions that require substantial staff time and energy, but for which near-term patient benefit is low (eg, extracorporeal life support and cardiopulmonary resuscitation for certain groups of seriously ill patients).