Becker's Clinical Quality & Infection Control

40 QUALITY IMPROVEMENT & MEASUREMENT Ethical resource allocation in the age of COVID-19: 6 tips By Anuja Vaidya H ealthcare workers face a wide ar- ray of pressures amid crises like a pandemic, including the pressure to ensure they are making ethical deci- sions with regard to resources. In an article published in e New En- gland Journal of Medicine, a group of in- ternational experts on medical ethics and health policy offered six recommendations to ensure patients receive equal treatment and scarce resources are allocated ethical- ly during the COVID-19 pandemic. Six expert recommendations: 1. Give priority to patients who are sick but could recover over patients who are unlikely to recover even if treated. "Because maximizing benefits is para- mount in a pandemic, we believe that removing a patient from a ventilator or an ICU bed to provide it to others in need is also justifiable and that patients should be made aware of this possibility at admission," they wrote. 2. Critical services and resources related to stemming the COVID-19 pandem- ic, such as testing, personal protective equipment, intensive care unit beds and ventilators, should go first to front-line healthcare workers and others who care for ill patients. "These workers should be given priority, not because they are somehow more worthy, but because of their instrumen- tal value. They are essential to pandemic response," the authors wrote. 3. Care services should be randomly allocated to COVID-19 patients who are expected to have similar outcomes, rather than on a first-come, first-served basis. A first-come, first-served ap- proach would unfairly benefit patients who live close to hospitals, encourage crowding (or even violence) when drugs or vaccines are being distributed and potentially exclude from treatment people who become sick later on in the pandemic timeline. "First-come, first-served is used for such resources as transplantable kidneys, where scarcity is long-standing and patients can survive without the scarce resource. Conversely, treatments for coronavirus address urgent need," the authors wrote. 4. When a vaccine becomes available, healthcare workers and first responders should be given priority with regard to get- ting the vaccine, followed by older adults. "Invoking the value of maximizing saving lives justifies giving older persons priority for vaccines immediately after healthcare workers and first responders," they wrote. 5. People who participate in research to prove the safety and effectiveness of vac- cines and therapies should receive some priority for COVID-19 treatments. "Their assumption of risk during their participation in research helps future patients, and they should be rewarded for that contribution," they wrote. But, research participation, "should serve only as a tiebreaker among patients with similar prognoses." 6. There should not be a difference in allocating scarce resources between COVID-19 patients and those with other medical conditions. "If the COVID-19 pandemic leads to absolute scarcity, that scarcity will affect all patients, including those with heart failure, cancer and other serious and life-threaten- ing conditions requiring prompt medical attention," the authors wrote. n Giving CPR during the pandemic: 3 tips By Anuja Vaidya U nder usual circumstances, cardiopulmonary resuscitation, or CPR, is provided to inpatients unless they have a do-not-resuscitate order on file, but the COVID-19 pandemic has changed considerations for providing CPR, according to a per- spective article published May 6 in The New England Journal of Medicine. Three physicians, who authored the article, offered these three recommendations for providing CPR during health crises in the hospital setting: 1. Let patients know about any resource constraints when discussing their care goals and DNR status with them. 2. Do not perform CPR in certain circumstances. For example, if ventilators or critical care beds are not avail- able; if the patient's condition is deteriorating signifi- cantly despite receiving critical care; or if the healthcare organization has a severe staffing shortage. 3. Place selective constraints on resuscitation if it en- sures healthcare personnel are protected. For example, hospitals could allow CPR to be performed only when personnel have put on appropriate protective gear. n

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