Scarce-Resource Allocation and Patient Triage During the COVID-19 Pandemic: JACC Review Topic of the Week

The COVID-19 pandemic and its sequelae have created scenarios of scarce medical resources, leading to the prospect that health care systems have faced or will face difficult decisions about triage, allocation, and reallocation. These decisions should be guided by ethical principles and values, shoul...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2020-07, Vol.76 (1), p.85-92
Main Authors: Kirkpatrick, James N, Hull, Sarah C, Fedson, Savitri, Mullen, Brendan, Goodlin, Sarah J
Format: Article
Language:English
Subjects:
Advance Care Planning - ethics
Advance Care Planning - organization & administration
Betacoronavirus - isolation & purification
Cardiology - standards
Cardiology - trends
Coronavirus Infections - epidemiology
Coronavirus Infections - therapy
COVID-19
Critical Pathways - trends
Health Care Rationing - methods
Health Care Rationing - organization & administration
Health Care Rationing - trends
Humans
Palliative Care - ethics
Palliative Care - organization & administration
Pandemics - ethics
Pneumonia, Viral - epidemiology
Pneumonia, Viral - therapy
Resource Allocation
SARS-CoV-2
Standard of Care
Triage - methods
Triage - trends
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Summary:The COVID-19 pandemic and its sequelae have created scenarios of scarce medical resources, leading to the prospect that health care systems have faced or will face difficult decisions about triage, allocation, and reallocation. These decisions should be guided by ethical principles and values, should not be made before crisis standards have been declared by authorities, and, in most cases, will not be made by bedside clinicians. Do not attempt resuscitation and withholding and withdrawing decisions should be made according to standard determination of medical appropriateness and futility, but there are unique considerations during a pandemic. Transparent and clear communication is crucial, coupled with dedication to provide the best possible care to patients, including palliative care. As medical knowledge about COVID-19 grows, more will be known about prognostic factors that can guide these difficult decisions.
ISSN:1558-3597
DOI:10.1016/j.jacc.2020.05.006