Development of an Electronic Medical Tool to Facilitate Allocation of Limited Resources in Times of Crisis.

The COVID-19 pandemic has made decisions about resource allocation and reallocation real possibilities even in high-resource settings. In April 2020, in preparation for such an eventuality, Atlantic Health System began to develop a real-time instrument built into the EMR to assist with such decisions. The instrument calculated the modified Sequential Organ Failure Assessment for all patients admitted, in real time, to assist triage teams make decisions if crisis standards of care were declared. A pilot assessment of the instrument was performed using retrospective data by nine members of the triage teams, who were asked to identify the six patients at highest risk of reallocation. Agreement about which patients were at highest risk of resource reallocation was good, but not perfect. All raters agreed on five of the six patients, but only seven of nine agreed on the final patient. Among the six consensus selections for reallocation, five died prior to hospital discharge. All patients at highest risk of reallocation had a predicted life expectancy of less than 1 year. In conclusion, the instrument was easy to use, and the concordance among raters was good but not perfect. Predicted life expectance was a major determinant of the triage score.