| Initial Interventions |
Restrict interventions only when:
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Patient/family preference
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Facility guideline details specific restriction
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Known nonbeneficial care (encourage consultation)
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Facility guideline for specific intervention (for example, dialysis, medication restrictions, ECMO restrictions)
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Consultants in domain (critical care, nephrology)
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Incident command—develop guidelines, approve changes to care strategies, assess local capacity and transfer options.
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Palliative care tools, resources, consultation
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Admission/
transfer decision |
Adjust threshold for admission according to resources available.
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Balance risk/benefit
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Shared/similar risk across facility/region
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Prioritize those with immediate life threats or highest consequences of delayed/deferred care.
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Arrange appropriate outpatient follow-up if safe to do so and resources do not allow admission.
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Facility/regional prioritization strategies (for example, emergent surgical needs, shock, high potential for deterioration)
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Expert provider interface with referring/admitting departments to prioritize patients for admission and inpatient location
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Information and process sharing across health care systems / centralized patient referral system (MOCC)
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Equal consideration for all patients regardless of location in facility / outside facility
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Social work and specialist support for obtaining outpatient services when resource shortages preclude admission
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| Ongoing care |
Assess resources required vs. benefit.
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Identify nonbeneficial care and engage triage team if needed.
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Identify restrictions on further interventions based on underlying prognosis (for example, limited resuscitation).
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Prioritize usual resources to most complex / most likely to benefit.
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Update patient care plan with family according to new information/changes.
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Standard assessment protocol/timing
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Assessment of benefit of continued care / intensity of continued care by clinical teams
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Expert provider support for specific clinical conditions / rationing decisions
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Clinical evidence for specific need/condition
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Facility guideline/policy
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“Bed Control” clinician to triage patients to most appropriate inpatient location
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Triage team used for withdrawal of nonbeneficial care or allocation decisions when involves withdrawal of life-sustaining care or competing demand for fixed resource (for example, ECMO)
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Palliative care tools, resources, consultation
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