The ethics of resource allocation from the perspective of pediatric icu providers: a pilot survey

Introduction: In 2011, the task force on Pediatric Emergency Mass Critical Care (PEMCC) noted that no North American emergency had overwhelmed ICU services since the modern development of critical care. During the COVID-19 global pandemic, resource allocation became a challenge and healthcare workers’ opinions of resource allocation had not been rigorously addressed in the literature. Our primary goal was to elucidate PICU providers’ opinions of various resource allocation strategies. Methods: An anonymous, electronic survey was sent to 173 PICU providers at a single institution - 47 MDs/APRNs and 126 RNs. Seven strategies for resource allocation were surveyed: (1) likelihood of survival; (2) age; (3) baseline neurologic status; (4) predicted length of time requiring resource; (5) lottery system; (6) first come first served; (7) immigration status. Each strategy was surveyed by three methods. First, a simple yes/no format was used to survey support of each resource allocation strategy. Second, the survey presented case scenarios and asked participants to choose a patient to receive the resource. Finally, participants ranked the strategies by importance. We analyzed data using descriptive statistics and average numerical rank. Results: Respondents included 19 MD/DOs/APRNs and 23 RNs. 85.7% believed the hospital should have a scarce resource allocation protocol. In response to various resource allocation strategies, participant “yes” responses were: 100% likelihood of survival; 83% baseline neurologic status; 81% time scarce resource required; 64% age; 5% first come first served; 5% lottery system; 2% immigration status. For case scenarios, majority of participants chose patients with a higher likelihood of survival, shorter time requiring scare resource and/or previously healthy status. The average rank of each strategy (most important scored 1): Likelihood of survival 1.14; Baseline neurologic status 2.98; Predicted length of time requiring resource 3.02; Age 3.9; Lottery system 4.81; First come first served 5.29; Immigration status 6.86. Conclusions: Likelihood of survival plays a consistently important role in determining resource allocation for PICU providers. Majority of providers believe a lottery system should not be used, yet many select a lottery system approach when faced with clinical scenarios.