A mixed-methods study to develop a jurisdiction-level resource allocation framework to guide the use of triage and triage-avoidant strategies during an overwhelming surge in demand for critical and acute care.

During the COVID-19 pandemic, many jurisdictions experienced overwhelming surges in demand for critical care. Some developed critical care triage frameworks or protocols in preparation for this eventuality, but most were able to avoid overt bedside triage (so far) through a combination of effective public health measures, reducing scheduled surgical care, and by increasing capacity through reallocation of existing staff, supplies and beds to provide the ICU care required, or moving patients to other hospitals (often some distance away) where ICU capacity still existed. These triage-avoidant strategies-strategies adopted across the health sector and via other public health and social measures-have led to unintended and not yet fully understood negative consequences for patients, family members, staff and healthcare organizations. Our current triage protocols are focused on patient-level decisions and do not address the consequences of system-level prioritization decisions (i.e., triage-avoidant strategies) that are made in a pandemic. To inform these decisions, we would benefit from a better understanding of their potential consequences. This question has an equity dimension, as both triage protocols and triage-avoidant strategies may have disproportionate effects on populations marginalized by race, disability, socioeconomic or health status, and other factors. Accordingly, in this project, we intend to collect and analyze health services data from Canada and use key stakeholder input to help interpret and contextualize this data. Ultimately, we plan to develop a jurisdiction-level resource allocation framework that could help decision-makers improve outcomes and mitigate the potentially disproportionate effect of future pandemics on marginalized populations.