Rationing Life

I originally posted this on 3/29. It bears repeating now.

It sounds Draconian, but this is the reality of what is around the corner.

A SOFA score is an assessment of patient morbidity and mortality in an ICU setting, or simply put, it gives an estimate of their prognosis. It uses a number of different variables to reach summary score. The SOFA score has been proposed as a triage tool for scarce medical resources for many years.

The linked document is meant as a template policy that could be adopted by different health systems and modified to their needs.

One thing that is worth noting is that there is an appeal process. However, given the volume of patients that will be needing ICU support during the pandemic, there was one line I found very interesting:

“The appeals process must occur quickly enough that the appeals process does not harm patients who are in the queue for scarce critical care resources currently being used by the patient who is the subject of the appeal.”

While people might be used to very long appeals processes in the normal day-to-day world, this will obviously be quite different and will need to be done very rapidly.

There is also a very good article titled “A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic” in JAMA on this topic.”

7/1 Addendum: Arizona took this step yesterday. Other states won’t be far behind.


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