Abstract
Purpose: This scoping review sought to identify objective factors to assist clinicians and policy-makers in making
consistent, objective and ethically sound decisions about resource allocation when healthcare rationing is inevitable.
Materials and methods: Review of guidelines and tools used in ICUs, hospital wards and emergency departments
on how to best allocate intensive care beds and ventilators either during routine care or developed during previous
epidemics, and association with patient outcomes during and after hospitalisation.
Results: Eighty publications from 20 countries reporting accuracy or validity of prognostic tools/algorithms, or significant correlation between prognostic variables and clinical outcomes met our eligibility criteria: twelve pandemic guidelines/triage protocols/consensus statements, twenty-two pandemic algorithms, and 46 prognostic tools/variables from non-crisis situations. Prognostic indicators presented here can be combined to create locally-relevant triage algorithms for clinicians and policy makers deciding about allocation of ICU beds and ventilators during a pandemic. No consensus was found on the ethical issues to incorporate in the decision to admit
or triage out of intensive care.
Conclusions: This review provides a unique reference intended as a discussion starter for clinicians and policy makers to consider formalising an objective a locally-relevant triage consensus document that enhances confidence in decision-making during healthcare rationing of critical care and ventilator resources.
consistent, objective and ethically sound decisions about resource allocation when healthcare rationing is inevitable.
Materials and methods: Review of guidelines and tools used in ICUs, hospital wards and emergency departments
on how to best allocate intensive care beds and ventilators either during routine care or developed during previous
epidemics, and association with patient outcomes during and after hospitalisation.
Results: Eighty publications from 20 countries reporting accuracy or validity of prognostic tools/algorithms, or significant correlation between prognostic variables and clinical outcomes met our eligibility criteria: twelve pandemic guidelines/triage protocols/consensus statements, twenty-two pandemic algorithms, and 46 prognostic tools/variables from non-crisis situations. Prognostic indicators presented here can be combined to create locally-relevant triage algorithms for clinicians and policy makers deciding about allocation of ICU beds and ventilators during a pandemic. No consensus was found on the ethical issues to incorporate in the decision to admit
or triage out of intensive care.
Conclusions: This review provides a unique reference intended as a discussion starter for clinicians and policy makers to consider formalising an objective a locally-relevant triage consensus document that enhances confidence in decision-making during healthcare rationing of critical care and ventilator resources.
Original language | English |
---|---|
Pages (from-to) | 33-43 |
Number of pages | 11 |
Journal | Journal of Critical Care |
Volume | 66 |
Early online date | 23 Aug 2021 |
DOIs | |
Publication status | Published - Dec 2021 |