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Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis.

by Selinger, Stephen.
Citation: Chest. 159(3):1076-1083, 2021 03.; .Journal: Chest.Published: 2021; ; ; ISSN: 0012-3692.Full author list: Belcher HM; Daugherty Biddison EL; Doberman DJ; D'Souza K; Ehmann MR; Fine DM; Garibaldi BT; Gehrie EA; Golden SH; Gurses AP; Hill PM; Hughes MT; Kachalia A; Kahn J; Koch CG; Levin AB; Marx JJ; Meisenberg BR; Natterman J; Rushton CH; Sapirstein A; Selinger SR; Stephens RS; Suarez JI; Toner ES; Unguru Y; van Stone M; Zink EK.UI/PMID: 32991873.Subject(s): *Civil Defense/og [Organization & Administration] | *COVID-19 | *Health Care Rationing | *Health Workforce | *Public Health/td [Trends] | *Resource Allocation | Change Management | COVID-19/ep [Epidemiology] | COVID-19/pc [Prevention & Control] | COVID-19/th [Therapy] | Disaster Planning | Health Care Rationing/mt [Methods] | Health Care Rationing/st [Standards] | Humans | Intersectoral Collaboration | Maryland/ep [Epidemiology] | Resource Allocation/es [Ethics] | Resource Allocation/og [Organization & Administration] | SARS-CoV-2 | Triage/es [Ethics] | Triage/og [Organization & Administration]Institution(s): MedStar Franklin Square Medical CenterDepartment(s): Pulmonary and Critical Care MedicineActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.chest.2020.09.246 (Click here) Abbreviated citation: Chest. 159(3):1076-1083, 2021 03; .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. Copyright (c) 2020. Published by Elsevier Inc.

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