Ethics

  • 1.  ICU Bed Allocation

    Posted 04-27-2021 09:21
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    All,

    A topic came up on the Ethics Committee call this week that I thought I would bring forward to this group. The discussion centered around rationing of ICU beds and how triaging is being addressed particularly in hospitals where surging is occurring or where a COVID ICU has not been established. Your thoughts?




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    Lori Harmon
    Director, Quality
    Society of Critical Care Medicine
    Mount Prospect IL
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    Attachment(s)



  • 2.  RE: ICU Bed Allocation

    Posted 04-28-2021 14:16

    Doug White is a leader in the field of resource allocation in critical care, and has been instrumental in discussions at a state and national level to address needs. Below is a list of some of his pertinent references:

     

    1. White DB, Lo B. Mitigating Inequities and Saving Lives with ICU Triage during the COVID-19 Pandemic. Am J Respir Crit Care Med. 2021 Feb 1;203(3):287-295. doi: 10.1164/rccm.202010-3809CP. PMID: 33522881
    2. Sönmez T, Pathak PA, Ünver MU, Persad G, Truog RD, White DB. Categorized Priority Systems: A New Tool for Fairly Allocating Scarce Medical Resources in the Face of Profound Social Inequities. Chest. 2021 Mar;159(3):1294-1299. doi: 10.1016/j.chest.2020.12.019. Epub 2020 Dec 26. PMID: 33373597
    3. Antiel RM, Curlin FA, Persad G, White DB, Zhang C, Glickman A, Emanuel EJ, Lantos JD. Should Pediatric Patients Be Prioritized When Rationing Life-Saving Treatments During COVID-19 Pandemic. Pediatrics. 2020 Sep;146(3):e2020012542. doi: 10.1542/peds.2020-012542. Epub 2020 Jul 9. PMID: 32647066
    4. White DB, Angus DC. A Proposed Lottery System to Allocate Scarce COVID-19 Medications: Promoting Fairness and Generating Knowledge. JAMA. 2020 Jul 28;324(4):329-330. doi: 10.1001/jama.2020.11464. PMID: 32579158
    5. Auriemma CL, Molinero AM, Houtrow AJ, Persad G, White DB, Halpern SD. Eliminating Categorical Exclusion Criteria in Crisis Standards of Care Frameworks. Am J Bioeth. 2020 Jul;20(7):28-36. doi: 10.1080/15265161.2020.1764141. Epub 2020 May 18. PMID: 32420822

     

    I think the concepts discussed in these articles should be the foundation for any decision making regarding resource allocation.

     

    Lori

    Lori Shutter, MD, FCCM, FNCS

    Vice Chair of Education

    Professor, Critical Care Medicine, Neurology, and Neurosurgery

    Director, Neurocritical Care Division

    Director, Multidisciplinary Critical Care Training Program

    UPMC / University of Pittsburgh School of Medicine

    Pittsburgh, PA 15261

    Office: 412-647-8410

    Assistant: Traci Green; greetk@upmc.edu