Resource allocation decisions faced by health care providers during the COVID-19 pandemic in a community intensive care unit in Ontario, Canada: a qualitative study.

PURPOSE: Insufficient resources and dynamic infection control policies during the COVID-19 pandemic necessitated that frontline health care providers (HCPs) make frequent ethical decisions about the allocation of scarce supplies, space, and clinician time to patient care activities. We aimed to understand the process, nature, and impact of these resource allocation decisions. METHODS: Using a qualitative case study approach, we developed an understanding of the decision-making of frontline intensive care unit (ICU) HCPs during the pandemic. We conducted 25 semistructured interviews with multidisciplinary HCPs employed in a community ICU in Ontario, Canada. We then extracted data related to resource allocation decisions and analyzed it within-case, using conventional (inductive) content analysis. RESULTS: Ethical decisions about resource allocation were ubiquitous for all types of HCPs within critical care practice. The constraints imposed by the pandemic and multiple provincial and organizational policies formed the context that necessitated these decisions. Health care providers drew upon a range of values in their decision-making, typically prioritizing HCP safety and patient well-being. Resulting actions included prioritizing clinical tasks, establishing boundaries, and modifying practice patterns. Although these situations commonly evoked stress and frustration among HCPs, feelings of self-efficacy, resourcefulness, and team cohesion were also described. CONCLUSIONS: Institutional policies and pragmatic limitations meant that HCPs in a community ICU in Ontario, Canada needed to make frequent ethical decisions about the allocation of scarce resources during the pandemic. These frequent decisions highlight the degree to which resource allocation is an inherent part of critical care. There is opportunity for targeted professional development to support allocation practices during adverse circumstances.