Ethical Triage and Scarce Resource Allocation During Public Health Emergencies: Tenets and Procedures

ABSTRACT Successful management of an event where health-care needs exceed regional health-care capacity requires coordinated strategies for scarce resource allocation. Publications for rapid development, training, and coordination of regional hospital triage teams to manage the allocation of scarce resources during coronavirus disease 2019 (COVID-19) are lacking. Over a period of 3 weeks, over 100 clinicians, ethicists, leaders, and public health authorities convened virtually to achieve consensus on how best to save the most lives possible and share resources. This is referred to as population-based crisis management. The rapid regionalization of 22 acute care hospitals across 4500 square miles in the midst of a pandemic with a shifting regulatory landscape was challenging, but overcome by mutual trust, transparency, and confidence in the public health authority. Because many cities are facing COVID-19 surges, we share a process for successful rapid formation of health-care care coalitions, Crisis Standard of Care, and training of Triage Teams. Incorporation of continuous process improvement and methods for communication is essential for successful implementation. Use of our regional health-care coalition communications, incident command system, and the crisis care committee helped mitigate crisis care in the San Diego and Imperial County region as COVID-19 cases surged and scarce resource collaborative decisions were required.

Download Full-text

Emergency Response to COVID-19 in Canada: Platform Development and Implementation for eHealth in Crisis Management (Preprint)

10.2196/preprints.18995 ◽

2020 ◽

Author(s):

Michael Krausz ◽

Jean Nicolas Westenberg ◽

Daniel Vigo ◽

Richard Trafford Spence ◽

Damon Ramsey

Keyword(s):

Public Health ◽

Health Care ◽

Resource Allocation ◽

Crisis Management ◽

Health Care Providers ◽

Care Providers ◽

Web Based ◽

Health Crisis ◽

Public Health Emergencies ◽

Management Platform

BACKGROUND Public health emergencies like epidemics put enormous pressure on health care systems while revealing deep structural and functional problems in the organization of care. The current coronavirus disease (COVID-19) pandemic illustrates this at a global level. The sudden increased demand on delivery systems puts unique pressures on pre-established care pathways. These extraordinary times require efficient tools for smart governance and resource allocation. OBJECTIVE The aim of this study is to develop an innovative web-based solution addressing the seemingly insurmountable challenges of triaging, monitoring, and delivering nonhospital services unleashed by the COVID-19 pandemic. METHODS An adaptable crisis management digital platform was envisioned and designed with the goal of improving the system’s response on the basis of the literature; an existing shared health record platform; and discussions between health care providers, decision makers, academia, and the private sector in response to the COVID 19 epidemic. RESULTS The Crisis Management Platform was developed and offered to health authorities in Ontario on a nonprofit basis. It has the capability to dramatically streamline patient intake, triage, monitoring, referral, and delivery of nonhospital services. It decentralizes the provision of services (by moving them online) and centralizes data gathering and analysis, maximizing the use of existing human resources, facilitating evidence-based decision making, and minimizing the risk to both users and providers. It has unlimited scale-up possibilities (only constrained by human health risk resource availability) with minimal marginal cost. Similar web-based solutions have the potential to fill an urgent gap in resource allocation, becoming a unique asset for health systems governance and management during critical times. They highlight the potential effectiveness of web-based solutions if built on an outcome-driven architecture. CONCLUSIONS Data and web-based approaches in response to a public health crisis are key to evidence-driven oversight and management of public health emergencies.

Download Full-text

Emergency Response to COVID-19 in Canada: Platform Development and Implementation for eHealth in Crisis Management

JMIR Public Health and Surveillance ◽

10.2196/18995 ◽

2020 ◽

Vol 6 (2) ◽

pp. e18995 ◽

Cited By ~ 9

Author(s):

Michael Krausz ◽

Jean Nicolas Westenberg ◽

Daniel Vigo ◽

Richard Trafford Spence ◽

Damon Ramsey

Keyword(s):

Public Health ◽

Health Care ◽

Resource Allocation ◽

Crisis Management ◽

Health Care Providers ◽

Care Providers ◽

Web Based ◽

Health Crisis ◽

Public Health Emergencies ◽

Management Platform

Background Public health emergencies like epidemics put enormous pressure on health care systems while revealing deep structural and functional problems in the organization of care. The current coronavirus disease (COVID-19) pandemic illustrates this at a global level. The sudden increased demand on delivery systems puts unique pressures on pre-established care pathways. These extraordinary times require efficient tools for smart governance and resource allocation. Objective The aim of this study is to develop an innovative web-based solution addressing the seemingly insurmountable challenges of triaging, monitoring, and delivering nonhospital services unleashed by the COVID-19 pandemic. Methods An adaptable crisis management digital platform was envisioned and designed with the goal of improving the system’s response on the basis of the literature; an existing shared health record platform; and discussions between health care providers, decision makers, academia, and the private sector in response to the COVID 19 epidemic. Results The Crisis Management Platform was developed and offered to health authorities in Ontario on a nonprofit basis. It has the capability to dramatically streamline patient intake, triage, monitoring, referral, and delivery of nonhospital services. It decentralizes the provision of services (by moving them online) and centralizes data gathering and analysis, maximizing the use of existing human resources, facilitating evidence-based decision making, and minimizing the risk to both users and providers. It has unlimited scale-up possibilities (only constrained by human health risk resource availability) with minimal marginal cost. Similar web-based solutions have the potential to fill an urgent gap in resource allocation, becoming a unique asset for health systems governance and management during critical times. They highlight the potential effectiveness of web-based solutions if built on an outcome-driven architecture. Conclusions Data and web-based approaches in response to a public health crisis are key to evidence-driven oversight and management of public health emergencies.

Download Full-text