Ethics Support for the Distribution of Hospital Beds: Co-Creating a Map of Values and Norms for the Allocation Meetings

"Background: Allocating admitted patients to their wards is increasingly put under pressure due to high bed occupancy rates. Consequently, allocation becomes morally challenging as it is confronted with potentially conflicting values like protecting teams’ workload, solidarity between wards and quality of care. Furthermore, there is a continuous uncertainty regarding expected intake, discharge, available beds and personnel. An integrative ethics support project was started to help to better deal with these challenges. After identifying core moral challenges, the aim of the current project was to co-create a map of values and norms for the daily allocation meetings. Methods: This qualitative study included observations of allocation meetings and 13 interviews. Subsequently, in five working group sessions a map of relevant values and norms was co-created with a selection of involved professionals. Results: Findings revealed moral challenges in three so-called ‘moral circles’: 1) one’s own team; 2) the hospital and 3) the hospital’s region. A map was developed including important and agreed upon values with 14 norms for the daily allocation meetings. Additionally, formal policies were updated and a conversation method was introduced to guide discussions when there are moral challenges. Conclusion: The joint development of the map led to a shared and practical product for both discussions and decisions regarding bed allocation. Its development already contributed to increased awareness of and openness about moral challenges. Using the map in daily allocation meetings may further stimulate moral reflection on these challenges to support these healthcare professionals in making well-considered and value-based decisions. "

Identification and Prioritization of Local Indicators of Hospital Bed Allocation in Iran

Background: The distribution of hospital beds can be used as an indicator for evaluating the distribution of health services. This study aimed to determine and prioritize indicators of bed allocation in Iran.Methods: In the first phase of the study we determined factors affecting bed distribution using a scoping review. In the second and third phases we applied expert panel and Delphi method to localize indicators of bed allocation. Finally, we carried out Analytic Network Process (ANP) approach based on Decision Making Trial and Evaluation Laboratory (DEMATEL) technique (DANP) to determine the weight and importance of indicators and to evaluate the causal relationship between them.Results: We identified 75 criteria affecting the distribution of beds through scoping review. In two rounds of Delphi, 28 criteria were agreed upon and entered into the DANP phase. Population, existence of a reference hospital in the area, the type of hospital (general/specialized), common diseases in the area, existence of home care services have had the most interaction with other variables. The variable of home care services was at the highest level of the causal chain.Conclusions: Bed occupancy rate, the average length of stay, waiting list, as well as type and level of the hospital had the highest priority in the distribution of hospital beds. Moreover, considering the importance of home care, policies should be adopted to expand these services nationwide. The criteria identified in this study will be helpful in developing policies aimed at equitable allocation of hospital beds considering the efficiency criteria.

Who Gets the Last Bed? A Discrete-Choice Experiment Examining General Population Preferences for Intensive Care Bed Prioritization in a Pandemic

Objective To explore the key patient attributes important to members of the Australian general population when prioritizing patients for the final intensive care unit (ICU) bed in a pandemic over-capacity scenario. Methods A discrete-choice experiment administered online asked respondents ( N = 306) to imagine the COVID-19 caseload had surged and that they were lay members of a panel tasked to allocate the final ICU bed. They had to decide which patient was more deserving for each of 14 patient pairs. Patients were characterized by 5 attributes: age, occupation, caregiver status, health prior to being infected, and prognosis. Respondents were randomly allocated to one of 7 sets of 14 pairs. Multinomial, mixed logit, and latent class models were used to model the observed choice behavior. Results A latent class model with 3 classes was found to be the most informative. Two classes valued active decision making and were slightly more likely to choose patients with caregiving responsibilities over those without. One of these classes valued prognosis most strongly, with a decreasing probability of bed allocation for those 65 y and older. The other valued both prognosis and age highly, with decreasing probability of bed allocation for those 45 y and older and a slight preference in favor of frontline health care workers. The third class preferred more random decision-making strategies. Conclusions For two-thirds of those sampled, prognosis, age, and caregiving responsibilities were the important features when making allocation decisions, although the emphasis varies. The remainder appeared to choose randomly.