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Table 4 Summary of guideline evolution at each development step

From: Developing a Thai national critical care allocation guideline during the COVID-19 pandemic: a rapid review and stakeholder consultation

Key content

Step 1: rapid review (first draft)

Step 2: key informant interview (second draft)

Step 3: multi-stakeholder consultation (final draft)

Guideline principle

Save the most lives

Save the most life-years

Benefit to others

Save the most lives

Save the most life-years

Benefit to others

Utilitarianism: saving the most lives

Prioritization criteria

Apply three-order criteria:

Clinical prognosis, e.g. SOFA, CFS; cognitive impairment assessment

Number of life-years saved

Social usefulness

Allocation decisions are based on relative scores

No cut-off score is applied

Apply three-order criteria:

Clinical prognosis using one or more of the following tools:

Charlson Comorbidity Index, SOFA, frailty assessment such as CFS, cognitive impairment assessment

Number of life-years saved

Social usefulness

Allocation decisions are based on relative scores

No cut-off score is applied

Assess patients based on clinical prognosis using at least two of the following tools:

Charlson Comorbidity Index, SOFA, frailty assessment such as CFS, cognitive impairment assessment

Allocation decisions are based on relative scores

No cut-off score is applied

Each health facility must apply the same sequence of tools consistently across all cases

Application

Applicable to all patients requiring critical care resources

Prior to ICU admission

Reassessment every 48 hours during ICU stay

Applicable to all patients requiring critical care resources

Prior to ICU admission

Reassessment every 48 hours during ICU stay

Applicable to all patients requiring critical care resources

Prior to ICU admission

Reassessment as appropriate during ICU stay

Decision-making

Triage committee of three healthcare professionals advises an attending physician on allocation

Attending physician is a decision-maker

Triage committee of three healthcare professionals advises an attending physician on allocation

Attending physician is a decision-maker

Patient review committee of five health and non-health experts advises an attending physician on allocation decision and communication with patient and families

Review process

Document assessment result and allocation decisions in a registry

Registry information can be reviewed by a staff/team in the hospital who are not involved in the first decision or external expert(s)

Appeal mechanism was proposed to be considered

Document assessment results and allocation decisions in a registry

Registry information can be reviewed by a staff/team in the hospital who are not involved in the first decision or external expert(s)

Appeal mechanism was proposed to be considered

Document assessment results and allocation decisions in a registry

Registry information can be reviewed by a staff/team in the hospital who are not involved in the first decision or external expert(s)

Implementation

When only 10–20% of critical care resources remain available

When only 10–20% of critical care resources remain available

National public health emergency AND

All efforts have been made to mobilize resources and demand still exceeds supply

Enforcement

The guideline is to be endorsed by the Medical Council of Thailand

The guideline is to be endorsed by the Medical Council of Thailand

The guideline is to be endorsed by the Medical Council of Thailand. Current status of endorsement is unclear due to the pandemic’s changing situation

  1. SOFA Sequential Organ Failure Assessment, CFS Clinical Frailty Scale