TABLE 3

COVID-19 ethical resource allocation approach at Cleveland Clinic

Resource allocation
• Recognize that pandemic crisis standards of care can interrupt access to care that is suspended temporarily in outpatient settings.
• Use a clinical decision support system in triage decision-making with validated criteria for limits (eg, SOFA scores, Multi-Organ Dysfunction Prediction Score (MODS), age).11,15
• Account for prognosis, comorbidities, and functional status in admission criteria to the ICU.
• Form triage teams that are distinct from bedside care team and are specific to allocation decision-making, to reduce moral distress during pandemic settings for the treating team.
Ethical responsibility to families
• Palliative care for discussions on advanced care planning or decision to withhold or withdraw life-sustaining treatments are done on an individual basis.
• Patients appropriately triaged to palliative care are notified of their right to discuss concerns or appeal decisions. In these situations, palliative care and ethics consultation services are readily accessible.
Ethical responsibility to healthcare workers
• Conservation and reallocation of resources make utilization more efficient and allow appropriate PPE to be made available to healthcare workers across settings such as the hospital, outpatient, long-term acute care facilities, and hospice.