Variation in COVID-19 Resource Allocation Protocols and Potential Implementation in the Chicago Metropolitan Area

Area of Science:

• Public Health
• Health Policy
• Critical Care Medicine

Background:

• Scarce resource allocation policies differ nationwide, with limited understanding of regional variations in protocols and their application.
• The study investigated COVID-19 scarce resource allocation protocols within the Chicago metropolitan area.
• It aimed to identify variations in policies and their practical application when prioritizing patients for critical care.

Purpose of the Study:

• To evaluate the variability of COVID-19 scarce resource allocation policies across Chicago metropolitan area hospitals.
• To assess differences in the application of these policies when prioritizing hypothetical patients for critical care resources.
• To understand the extent of agreement in patient prioritization among healthcare professionals within and across institutions.

Main Methods:

• Two cross-sectional surveys were administered to hospital representatives and triage officers in the Chicago metropolitan area.
• Survey responses were analyzed for frequencies, and variations in patient ranking were assessed using Fleiss's Kappa coefficients.
• Eight hospitals provided data on ventilator allocation protocols, and nine hospitals provided data from triage officers.

Main Results:

• Seven of eight surveyed hospitals (86%) utilized the Sequential Organ Failure Assessment (SOFA) score for initial patient scoring.
• A majority of hospitals prioritized pre-defined groups (71%) and discussed mechanical ventilation withdrawal (100%).
• Triage officers exhibited low agreement (Kappa=0.158) in ranking hypothetical patients, with only fair agreement within individual hospitals (Kappa=0.21-0.25).

Conclusions:

• Significant variations exist in the substance and application of COVID-19 scarce resource allocation protocols among Chicago-area hospitals.
• The low agreement in prioritizing patients highlights potential inequities in resource distribution.
• Such disparities can exacerbate community distrust and worsen existing health inequities.