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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
Journal article   Open access   Peer reviewed

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

Albert Nadjarian, Jessica LeClair, Taylor F Mahoney, Eric H Awtry, Jasvinder S Bhatia, Lisa B Caruso, Alexis Clay, David Greer, Karan S Hingorani, L F B Horta, …
Critical care medicine, Vol.49(10), pp.1739-1748
10/01/2021
DOI: 10.1097/CCM.0000000000005155
PMCID: PMC8439631
PMID: 34115635
url
https://doi.org/10.1097/CCM.0000000000005155View
Published (Version of record) Open Access

Abstract

The coronavirus disease 2019 pandemic has overwhelmed healthcare resources even in wealthy nations, necessitating rationing of limited resources without previously established crisis standards of care protocols. In Massachusetts, triage guidelines were designed based on acute illness and chronic life-limiting conditions. In this study, we sought to retrospectively validate this protocol to cohorts of critically ill patients from our hospital. We applied our hospital-adopted guidelines, which defined severe and major chronic conditions as those associated with a greater than 50% likelihood of 1- and 5-year mortality, respectively, to a critically ill patient population. We investigated mortality for the same intervals. An urban safety-net hospital ICU. All adults hospitalized during April of 2015 and April 2019 identified through a clinical database search. None. Of 365 admitted patients, 15.89% had one or more defined chronic life-limiting conditions. These patients had higher 1-year (46.55% vs 13.68%; p < 0.01) and 5-year (50.00% vs 17.22%; p < 0.01) mortality rates than those without underlying conditions. Irrespective of classification of disease severity, patients with metastatic cancer, congestive heart failure, end-stage renal disease, and neurodegenerative disease had greater than 50% 1-year mortality, whereas patients with chronic lung disease and cirrhosis had less than 50% 1-year mortality. Observed 1- and 5-year mortality for cirrhosis, heart failure, and metastatic cancer were more variable when subdivided into severe and major categories. Patients with major and severe chronic medical conditions overall had 46.55% and 50.00% mortality at 1 and 5 years, respectively. However, mortality varied between conditions. Our findings appear to support a crisis standards protocol which focuses on acute illness severity and only considers underlying conditions carrying a greater than 50% predicted likelihood of 1-year mortality. Modifications to the chronic lung disease, congestive heart failure, and cirrhosis criteria should be refined if they are to be included in future models.
 Academic Medical Centers - organization & administration Academic Medical Centers - statistics & numerical data Adult COVID-19 - epidemiology COVID-19 - therapy Crisis Intervention - methods Crisis Intervention - standards Crisis Intervention - statistics & numerical data Female Hospitalization - statistics & numerical data Humans Male Massachusetts Middle Aged Resource Allocation - methods Resource Allocation - statistics & numerical data Retrospective Studies Safety-net Providers - organization & administration Safety-net Providers - statistics & numerical data Standard of Care - standards Standard of Care - statistics & numerical data Urban Population - statistics & numerical data

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