Posted on March 21, 2020 at 1:03 PM
How to allocate scarce resources (e.g., ventilators/ICU beds) is a critically important issue to get right. Unfortunately, there are some really problematic approaches to triage that are being floated across the country. For example, some policies categorically exclude large groups of citizens without providing good reasons. Others focus narrowly on survival to hospital discharge without any consideration of trying to also increase the number of life-years saved.
Douglas White (University of Pittsburgh) and colleagues have developed an allocation framework that is being adopted by more than 100 hospitals and across the country (including Johns Hopkins, UPMC, Penn, Penn St, MedStar hospitals, and University of Maryland hospitals). In addition, a Maryland hospital consortium is requesting that the state emergently endorse this type of allocation framework for Maryland hospitals.
This allocation framework is the best available strategy for allocating ventilators and ICU beds during a pandemic such as the current situation. It is ethically defensible, operationally feasible, and has been vetted with community stakeholders. It does not use the highly problematic exclusion criteria that are pervasive in existing triage protocols. And it goes beyond trying to maximize solely the number of individuals that survive to hospital discharge, and instead also strives to maximize the life-years saved.
There is tremendous value to both patients and hospitals to have a consistent allocation framework for critical care/ventilators across hospitals.