SCCM Resource Library-Implicit Versus Explicit Limitation of Scarce Critical Care Resources

Pdf Summary

The document is a piece from the "CriticalConnections" Summer 2021 issue, discussing ethical dilemmas faced by healthcare providers during the COVID-19 pandemic, specifically regarding the allocation of scarce resources in hospitals. An intensive care physician at a tertiary care hospital must decide the course of treatment for an 84-year-old patient with COVID-19 and multiple comorbidities. The decision to potentially withhold intensive care unit (ICU) interventions is complicated by the lack of an officially declared state of emergency or invocation of a crisis standard-of-care plan, although ICU beds are near full capacity.<br /><br />The ethical analysis highlights the conflict between individual patient care and the broader necessity to optimize community health outcomes during times of crisis. In particular, the physician's unilateral decision to label the patient as do not resuscitate/do not intubate without consulting broader crisis protocols or transparently communicating with the patient’s family may have stemmed from unconscious biases or an incomplete understanding of available resources.<br /><br />The article argues for the importance of established, transparent resource allocation algorithms and suggests that involving upper-level administration might mitigate the imperfections of individual judgement. Employing uniform crisis standards could prevent unnecessary limitation of care and potential legal liabilities. The document underscores the need for healthcare systems to communicate such standards effectively to patients and the community, maintaining public trust.<br /><br />Additionally, the document includes an advertisement for a self-directed Neurocritical Care Review Course, providing continuing education credit for healthcare professionals. This course aims to prepare participants for the Subspecialty Certification in Neurocritical Care examination, covering neurocritical care disease evaluation, multisystem care, and diagnostic neuroimaging principles.

Asset Subtitle

Crisis Management, Ethics End of Life, 2021, 00:03:45

Asset Caption

This article was first published in the Summer 2021 issue of Critical Connections.

An intensive care medicine attending physician works at a tertiary care hospital. Six weeks into the COVID-19 pandemic, the medical intensive care unit (MICU) has been operating at an average of 95% capacity. All the hospital beds that could be transitioned to ICU-level to accommodate the overflow of critically ill patients were transitioned weeks ago. Elective admissions and surgeries are going forward on a case-by-case basis. The hospital created a resource allocation algorithm at the beginning of the pandemic but it has not been used because the state’s governor has not declared an official state of emergency.

Critical Connections, the critical care industry's only newsmagazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team.Jessica M. Turnbull, MD, MA
Erin M. Johnson, MD, MA, FAAP
David A. Oxman, MD, HEC-C

Meta Tag

Content Type Article

Knowledge Area Crisis Management

Knowledge Area Ethics End of Life

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag COVID-19

Tag Resource Allocation

Year 2021

Keywords

ethical dilemmas

COVID-19 pandemic

scarce resources

intensive care

crisis standard-of-care

resource allocation

unconscious biases

public trust

Neurocritical Care

continuing education

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