Minnesota Hospitals’ Plans for Implementing Statewide Guidance on Allocation of Scarce Critical Care Resources During the COVID-19 Pandemic

Abstract

ObjectivesTo assess hospitals’ plans for implementing Minnesota’s statewide guidance for allocating scarce critical care resources during the COVID-19 pandemic. Patients and MethodsIndividuals from 23 hospitals across Minnesota were invited to complete a 25-item survey between July 20, 2020, and September 18, 2020 to understand how hospitals in the state intended to operationalize statewide clinical triage instructions for scarce resources (including mechanical ventilation) and written ethics guidance on the allocation of critical care resources in the event crisis standards of care were triggered. ResultsOf individuals invited from 23 hospitals, 14 hospitals completed the survey (60.9% institutional response rate) and described plans for triage at their respective hospitals. Planned triage team composition and size varied. Hospitals’ plans for which individuals should assign a triage score (reflecting patients’ illness severity) also differed markedly. Most respondents described plans for staff training to address potential bias in triage. ConclusionDespite explicit state guidance to encourage consistency across hospitals, these facilities found considerable heterogeneity. They diverged from the state’s written ethics guidance on whether to consider race during triage to help mitigate health disparities. Inconsistencies between the state’s 2 guidance documents could explain some of these differences. Collaboration between hospitals and committees developing statewide guidance may help identify barriers to effective operationalization. Ongoing review of published guidance and hospital plans can identify issues of clarity and consistency and promote equitable triage.