Developing a Thai national critical care allocation guideline during the COVID-19 pandemic: a rapid review and stakeholder consultation
نویسندگان
چکیده
Abstract Background At the height of COVID-19 pandemic, Thailand had almost depleted its critical care resources, particularly intensive unit (ICU) beds and ventilators. This prompted necessity to develop a national guideline for resource allocation. paper describes development process allocation in during pandemic. Methods The consisted three steps: (1) rapid review existing rationing guidelines literature; (2) interviews Thai clinicians experienced caring cases; (3) multi-stakeholder consultations. steps 1 2, data was synthesized categorized using thematic content analysis approach, this guided formulation draft guideline. Within step 3, debated finalized before entering policy-decision stage. Results Three-order prioritization criteria consisting clinical prognosis four tools (Charlson Comorbidity Index, Sequential Organ Failure Assessment, frailty assessment cognitive impairment assessment), number life-years saved social usefulness were proposed by research team based on literature reviews interviews. consultations, stakeholders rejected as criterion due potential age gender discrimination, well utility concern it would foster public distrust, judgement can be arbitrary. It agreed that attending physician is required decision-maker medico-legal context, while patient committee play an advisory role. Allocation decisions are documented transparency, no appealing mechanism applied. will triggered only when demand exceeds supply after utmost efforts mobilize surge capacity. Once implemented, applicable all patients, non-COVID-19, requiring resources prior ICU admission stay. Conclusions context outbreak informed scientific evidence, norms societal values reduce risk distrust given sensitive nature issue ethical dilemmas guiding principle, though conducted at record speed. Our lessons provide insight similar guidelines, especially other low- middle-income countries.
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ژورنال
عنوان ژورنال: Health Research Policy and Systems
سال: 2021
ISSN: ['1478-4505']
DOI: https://doi.org/10.1186/s12961-021-00696-z