This article reports on the Ohio Hospital Association’s adoption of new guidance for allocating scarce resources during a public health emergency, including recommending the use of a triage committee rather than bedside personnel to make allocation decisions. The guidance also addresses other resource allocation strategies, such as modifications to licensure requirements to increase available health care workforce and expansion of telehealth and community paramedicine to alleviate surge.
The Ohio Hospital Association guidelines are explicitly informed by the work of the Institute of Medicine’s 2009 report on crisis standards of care, and an association spokesperson also indicated that the plan was developed using a variety of other federal and state templates on resource allocation.
The full Ohio Hospital Association report is available here. It cites as key ethical considerations fairness, duty to care, duty to steward resources, transparency, consistency, proportionality, and accountability. The report suggests that hospitals utilize a triage team composed of representatives from medical staff, nursing, and ethics be responsible for collecting scoring data, calculating triage scores, identifying patient who quality or no longer quality for scarce resources, and maintaining appropriate documentation of triage decisions and rationale. The report notes that hospitals will develop their own specific approaches, but recommends that an objective tool removes bedside providers from the decision and provides a fair and consistent method for allocation.
The report recommends the following exclusion criteria for critical care intervention:
- Patients unlikely to benefit from critical care intervention
- Patients with low probability of survival despite care
- Patients requiring resources that cannot be provided
- Patients with poor prognosis and high likelihood of death due to underlying illness
- SOFA score equal to or greater than 11
- Unwitnessed and/or recurrent cardiac arrest
- Severe trauma with predicted mortality of >90%
- Severe burns with predicted mortality of >90%
- Incurable metastatic malignant disease
- Advanced and irreversible immune-compromised condition
- Known or previously documented end-state organ failure (with specific criteria)
- Patient preference to be excluded.