Approaches to critical care resource allocation and triage during the COVID-19 pandemic: an examination from a developing world perspective

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Canadian emergency medicine and critical care physician perspectives on pandemic triage in COVID-19

Introduction: Local and regional policies to guide the allocation of scarce critical care resources have been developed, but the views of prospective users are not understood. We sought to investigate the perspectives of Canadian acute care physicians toward triaging scarce critical care resources in the COVID-19 pandemic.Methods: We rapidly deployed a brief survey to Canadian emergency and critical care physicians in April 2020 to investigate current attitudes toward triaging scarce critical care resources and identify subsequent areas for improvement. Descriptive and between-group analyses along with thematic coding were used.Results: The survey was completed by 261 acute care physicians. Feelings of anxiety related to the pandemic were common (65 percent), as well as fears of psychological distress if required to triage scarce resources (77 percent). Only 49 percent of respondents felt confident in making resource allocation decisions. Both critical care and emergency physicians favored multidisciplinary teams over single physicians to allocate scarce critical care resources. Critical care physicians were supportive of decision making by teams not involved in patient care (3.4/5 versus 2.9/5 p = 0.04), whereas emergency physicians preferred to maintain their involvement in such decisions (3.4/5 versus 4.0/5 p = 0.007). Free text responses identified five themes for subsequent action including the need for further guidance on existing triage policies, ethical support in decision making, medicolegal protection, additional tools for therapeutic communications, and healthcare provider psychological support.Conclusion: There is an urgent need for collaboration between policymakers and frontline physicians to develop critical care resource triage policies that wholly consider the diversity of provider perspectives across practice environments.

Comparing COVID-19 Critical Care Admissions by Minority Populations to Pre-COVID-19 Critical Care Utilization

Background: Several months into the COVID-19 pandemic, reassessing intensive care unit (ICU) utilization, specifically with regional impact on diverse populations, should be a priority for hospitals planning for critical care resource allocation. In our study, we reviewed the impact of COVID-19 on a community hospital serving an urban region, comparing the sociodemographic distribution of ICU admissions before and during the pandemic. Methods: We executed a time sensitive analysis to see if COVID-19 ICU admissions reflect regional sociodemographic populations as well as ICU admission trends prior to the current pandemic. Collected sociodemographic variables included sex, race, ethnicity, and age of adult patients (age 18 and older) admitted to the hospital’s medical and cardiac ICUs, which were converted to COVID-19 ICUs. The time period selected was 18-months, which was then dichotomized into pre-COVID-19 admissions (December 1, 2018 to March 13, 2020) and COVID-19 ICU admissions (March 14, 2020 to May 31, 2020). Variables were compared using Fisher’s exact tests and Wilcoxon tests when appropriate.Results: During the 18-month period, 1861 patients were admitted to the aforementioned ICUs. The mean age of the 1861 patients was 62.75 + 15.57 years old, with the majority of these patients being male (52.23%), White (64.43%), and non-Hispanic/Latinx (95.75%). There were differences in racial and ethnic distribution comparing pre-COVID-19 admissions to the COVID-19 admissions. Compared to pre-COVID-19 ICU admissions, there was an increase in African American versus White admissions (p=0.01) and an increase in Hispanic/Latinx versus non-Hispanic/Latinx admissions (p<0.01), during the COVID-19 pandemic.Discussion: During the first three months of admissions to COVID-19 ICUs, there was a rise in admissions among Hispanic/Latinx and African-American patients, while non-Hispanic/Latinx and White patient admissions declined compared to the previous pre-COVID year. These findings support development of strategies to enhance allocation of resources to bolster novel, equitable strategies to mitigate the incidence of COVID-19 in minority populations.