Resource Allocation

Influence of Geopolitics on Severity and Outcome in COVID-19*

From Critical Care Medicine In this Editorial the authors write an accompanying piece to Mesotten et al. 

Managing Patients With COVID-19 in Resource-Limited Areas

During this webcast, subject matter experts addressed questions on how to manage patients with COVID-19 in a rural location with limited resources, how to treat patients with limited equipment, and how to manage resources when there are bed shortages.

In COVID-19 Patients Who Suffer In-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation Outcomes May Be Impacted by Arrest Etiology and Local Pandemic Conditions

From Critical Care Explorations The authors describe outcomes after cardiopulmonary resuscitation for in-hospital cardiac arrest in two COVID-19 patient cohorts.

Functionality of Scarce Healthcare Resource Triage Teams During the COVID-19 Pandemic: A Multi-Institutional Simulation Study

From Critical Care Explorations The authors conducted eleven team triage simulations from December 2020 through February 2021. 

HHS Resource: COVID-19 Therapeutics Locator

The national map below displays public locations that have received shipments of U.S. Government-procured COVID-19 therapeutics under U.S. Food and Drug Administration (FDA) Emergency Use Authorization (EUA) authority. The locations displayed in the locator have reported stock on hand within the last day.

NIH Resource: The COVID-19 Treatment Guidelines Panel’s Interim Statement on Patient Prioritization for Outpatient Anti-SARS-CoV-2 Therapies or Preventive Strategies When There Are Logistical or Supply Constraints

The COVID-19 Treatment Guidelines Panel (the Panel) has recommended several therapeutic agents for the treatment and prevention of SARS-CoV-2 infection in individuals who are at high risk for progression to severe COVID-19. These anti-SARS-CoV-2 therapeutics are of greatest benefit for nonhospitalized patients who have risk factors for progression to severe COVID-19. With the increase in cases of COVID-19 and the emergence of the Omicron (B.1.1.529) variant of concern, there may be logistical or supply constraints that make it impossible to offer the available therapy to all eligible patients, making patient triage necessary. 

Critical Impact: COVID-19: Highlights Session 3

This webinar covers highlights from the Critical Impact:  Ethics and Supply Chain course.

Critical Impact: COVID-19: Highlights Session 2

This webinar covers highlights from the Critical Impact: Infrastructure and Workforce course.

ICU Mortality in Patients With Coronavirus Disease 2019 Infection: Highlighting Healthcare Disparities in Rural Appalachia

From Critical Care Explorations.  The authors found that critically ill and mechanically ventilated coronavirus disease 2019 acute respiratory distress syndrome patients transferred from Appalachian critical access hospitals/rural facilities have increased mortality compared with noncoronavirus disease 2019 acute respiratory distress syndrome controls, suggesting that lack or delay in access to tertiary care may impact coronavirus disease 2019 outcome in rural areas. 

Best Practices for Managing Staff Shortages

During the COVID-19 pandemic, healthcare systems have been overwhelmed with patients, leading to clinician burnout and staffing issues. In this free webcast, learn how leaders from various intensive care units are managing staff shortages Webcast Recorded on Thursday, October 7, 2021. This webcast is cosponsored by the American Association of Critical-Care Nurses.

What suggestions do you have for pharmacists, physician assistants, nurses, and physicians who work in a traditionally non-ICU environment who want to obtain further skills and knowledge to care for critically ill, difficult-to-manage patients?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on September 8, 2021

Validation of a Crisis Standards of Care Model for Prioritization of Limited Resources During the Coronavirus Disease 2019 Crisis in an Urban, Safety-Net, Academic Medical Center

From Critical Care Medicine. In Massachusetts, triage guidelines were designed based on acute illness and chronic life-limiting conditions. In this study, the authors sought to retrospectively validate this protocol to cohorts of critically ill patients from their hospital.

Operationalizing Ethical Guidance for Ventilator Allocation in Minnesota: Saving the Most Lives or Exacerbating Health Disparities?

From Critical Care Explorations. In this article, the authors note that the Ventilator Allocation Score can accurately identify patients with high rates of short-term mortality. However, these high mortality patients only represent 27% of all the patients who died, limiting the utility of the score for allocation of scarce resources. The score may unfairly prioritize older patients and inadvertently exacerbate racial health disparities through the inclusion of specific comorbidities such as end stage renal disease. Triage frameworks that include age should be considered. Purposeful efforts, the authors say, must be taken to ensure that triage protocols do not perpetuate or exacerbate prevailing inequities.

Scarce Resource Allocation in a Pandemic: A Protocol to Promote Equity, Timeliness, and Transparency

From Critical Care Explorations. Drawing on expertise in critical care medicine, bioethics, and political science, the authors propose a decision-making protocol to ensure fairness in the resolution of conflict, timely decision-making, and accountability to improve system response.

Frugal Innovation: Enabling Mechanical Ventilation During Coronavirus Disease 2019 Pandemic in Resource-Limited Settings

From Critical Care Explorations. In this commentary, the authors note that low-quality care has become a greater determinant of mortality than lack of access. To address this, they suggest a systems-wide approach to improving the quality of mechanical ventilation in resource-limited settings, which includes consideration of the interdependent ventilator design constraints such as cost and complexity, hospital infrastructure, availability of medications, and trained personnel.

Does your institution provide guidelines as to when a patient with COVID-19 needs intensive care? Do these parameters change based on hospital capacity?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on March 10, 2021

Rapid Development of a Tool for Prioritizing Patients with Coronavirus Disease 2019 for Intensive Care

From Critical Care Explorations. In this study, the authors share a new approach for rapidly developing a decision-support tool for prioritizing patients with coronavirus 2019 disease for admission to ICUs.

ICU Bed Utilization During the Coronavirus Disease 2019 Pandemic in a Multistate Analysis—March to June 2020

From Critical Care Explorations. The authors examined ICU census trends in relation to ICU bed capacity during the rapid increase in severe coronavirus disease 2019 cases early during the pandemic, and concluded they concluded tha ttheir findings demonstrate the short-term adaptability of U.S. healthcare institutions in redirecting limited resources to accommodate a public health emergency.

Collaboration Between Tele-ICU Programs Has the Potential to Rapidly Increase the Availability of Critical Care Physicians—Our Experience Was During Coronavirus Disease 2019 Nomenclature

From Critical Care Explorations.  The authors describe implementing a connected network between two tele-ICU programs to support staffing and rounding during the first wave of the coronavirus disease 2019 pandemic in the United States.

The Effects of ICU Crisis Reorganization on Outcomes in Patients Not Infected With Coronavirus Disease 2019 During the Initial Surge of the Coronavirus Disease 2019 Pandemic

From Critical Care Explorations. In this study, the authors determined if ICU reorganization due to the coronavirus disease 2019 pandemic affected outcomes in critically ill patients who were not infected with coronavirus disease 2019.

Nursing Staffing Models: Telemetry Contingency & Crisis Model

This is a nursing staffing model for telemetry contigencies. This is a community developed COVID-19 microlearning resource.

Nursing Staffing Models: DSU (Stepdown) Contingency Staffing Model

This is a nursing staffing model DSU (Stepdown) contingencies. This is a community developed COVID-19 microlearning resource.

Nursing Staffing Models: Med-Surg Contingency & Crisis Model

This is a nursing staffing model for Med-Surg emergency contingencies and crises. This is a community developed COVID-19 microlearning resource.

Nursing Staffing Models: ICU Staffing Plan: Contingency & Crisis Model

This is a nursing staffing model for the ICU. This is a community developed COVID-19 microlearning resource.

Nursing Staffing Models: Emergency Contingency Staffing

This is a nursing staffing model for emergency contingencies. This is a community developed COVID-19 microlearning resource.

CDC Resources: Infection

SCCM’s COVID-19 Rapid Resource Center now links to pertinent content from the Centers for Disease Control and Prevention (CDC). These resources are categorized as Infection   

Federal Healthcare Resilience Working Group (HRWG): Surge Roadmap Slides

The Federal Healthcare Resilience Working Group (HRWG) created Strategies for Managing a Surge in COVID-19 Cases, also referred to as the Surge Roadmap, to provide guidance to the state, tribal, local, and territorial (STLT) jurisdictions on how to enhance their healthcare capabilities in response to a surge in COVID-19 cases.

What advice do you have regarding core skills for the medical surgical nurse, general hospital pharmacist, hospitalist, or emergency physician without dedicated critical care training who will be joining your team to help care for these patients, perhaps

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on December 9, 2020.

Letter to the Editor: Breaking Silos: The Team-Based Approach to Coronavirus Disease 2019 Pandemic Staffing

From Critical Care Explorations

The authors describe experiences and lessons learned at NewYork-Presbyterian (NYP), one of the largest healthcare delivery systems in the United States, in creating an intercampus leadership teams to combat COVID-19.

Editorial: Cardiopulmonary Resuscitation in Coronavirus Disease 2019: Rebalancing Risk, Reward, and Autonomy

From Critical Care Medicine

In this editorial, the authors discuss the risks of healthcare professionals performing cardiopulmonary resuscitation on coronavirus disease 2019 patients.

Rapid Transition of a PICU Space and Staff to Adult Coronavirus Disease 2019 ICU Care

From Critical Care Medicine

The authors describe how a PICU and a PICU care team were incorporated into a hospital-wide ICU care model during the coronavirus disease 2019 pandemic.

How does an emergency department nurse apply her skills to the ICU when asked to work as an ICU nurse? Does your hospital use any type of tiered staffing? Do you incorporate non-ICU nurses or non-ICU physicians into your ICU staffing?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on November 4, 2020.

What are your thoughts about triage for ICU admission, lack of equipment, lack of PPE, and lack of dialysis equipment?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on August 12, 2020.

How was nurse staffing handled at your institution? Did you design a tiered staffing system for ICU nurses or did you use nurses from other departments? What was your experience with the nursing staff?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on August 12, 2020.

How did your institution handle incorporating fellows, residents, and other non-ICU clinicians into a tiered staffing system? Did they care for patients? What do you recommend?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on August 12, 2020.

Three-Dimensional Printed Ventilators: A Rapid Solution to Coronavirus Disease 2019–Induced Supply-Chain Shortages

From Critical Care Explorations. In this paper, the authors report that three-dimensional printed ventilators, such as "CRISIS," propose a potential solution to increase the available number of vents for the United States and abroad, one that is dynamic and able to absorb the massive influx of hospitalized patients for the foreseeable future.

Letter to the Editor: Transforming a PICU Into an Adult ICU During the Coronavirus Disease 2019 Pandemic: Meeting Multiple Needs

From Critical Care Explorations. In this Letter to the Editor, the authors describe the process converting half of their 40-bed PICU into a negative-pressure biocontainment ICU dedicated to adult coronavirus disease 2019 patients within a 1,003-bed academic quaternary hospital.

Alternative Analgesic and Sedative Agents in the Setting of Drug Shortages during the COVID19 Pandemic

This resources detail how to manage drug shortages for alternative analgesics and sedagent agents. This is SCCM curated COVID-19 microlearning content.

SCCM Pod-418 COVID-19 Learning: Conversion of a Children's Hospital to an Adult Hospital

Montefiore Medical Center in the Bronx, New York, USA, quickly converted a children's hospital to an adult COVID-19 hospital. Hear Margaret M. Parker, MD, MCCM, talk with H. Michael Ushay, MD, PhD, FAAP, FCCM, about the process, challenges with staffing and personal protective equipment, and more.

Design for Implementation of a System-Level ICU Pandemic Surge Staffing Plan

From Critical Care Explorations. The authors provide a description of the design, dissemination, and implementation of an ICU surge provider staffing algorithm, focusing on physicians, advanced practice providers, and certified registered nurse anesthetists, at a system-wide level.

How were non-ICU nurses brought up to speed to care for patients that overflowed from the ICU?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on June 10th, 2020.

Establishing Pharmacy Services in an Alternate Care Site

This presentation discusses how to best organize a pharmacy at an alternate care site. This is SCCM curated COVID-19 microlearning content.

Managing Shortages: Principles of Allocation in Crisis Situations

This presentation covers how to ethically manage shortages and resource allocations. This is SCCM curated COVID-19 microlearning content.

How is PPE allocated in your hospital? How are decisions made as to when to reuse it and when to discard it

In this question and answer webcast series, attendees had an opportunity to pose questions about managing critically ill patients with COVID-19 and other issues. Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were also answered. Recorded on: Friday, May 22, 2020

What is your perspective on personal safety and PPE availability for nurses?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on May 27th, 2020.

What are some strategies for providing care with limited resources?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on May 13th, 2020.

SCCM Pod-416 COVID-19 Learning: Multiple Patients on a Single Ventilator

In a situation where ventilators are in short supply, multiple patients on a single ventilator could be a strategy of last resort.

Adult ICU Triage During the Coronavirus Disease 2019 Pandemic: Who Will Live and Who Will Die? Recommendations to Improve Survival

From Critical Care Medicine. The authors discuss the major issues related to ICU triage and try to give recommendations where appropriate but also give different choices for certain issues for countries based on what is best for them.

Caring for Critically Ill Adults in PICUs Is Not "Child's Play"

From Pediatric Critical Care Medicine. Editorial by authors that led the Pediatric Emergency Mass Critical Care Task Force and 2014 Task Force for Mass Critical Care.

Caring for Critically Ill Adults With Coronavirus Disease 2019 in a PICU: Recommendations by Dual Trained Intensivists

From Pediatric Critical Care Medicine. Although pediatric intensivists are well versed in the care of ARDS from viral pneumonia, the care of an differing aged adult populations presents some unique challenges.

What is the best way to handle bed expansion for critical care and reopening shuttered facilities?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered.

Society of Critical Care Medicine Crisis Standard of Care Recommendations for Triaging Critical Resources During the COVID-19 Pandemic

The purpose of these recommendations is to provide a transparent, equitable, and consistent approach to allocation of scarce resources during a COVID-19-declared emergency in which crisis standards of care have been implemented.

What are your thoughts on recycling PPE?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Question and Answer Webcast Series - Webcast 2 held on April 10, 2020.