The COVID-19 health crisis made a big dent in hospitals' resources making it more difficult, especially for frontline clinicians, to provide optimal care for patients, according to a new U.S. study (Butler et al. 2020).


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While medical institutions in general adopted a systematic approach to resource allocation in crisis settings, study authors note this approach did not address many challenges encountered by frontline clinicians, leaving them to make difficult allocation decisions that could compromise care.


The Institute of Medicine (IOM), for instance, has created a framework to guide care in resource-limited emergency settings. The aim is to optimise resource allocation so that frontline clinicians are spared from making rationing decisions at the bedside. Other national organisations have also developed similar frameworks, which are helpful in promoting fairness through transparent resource allocation processes.


However, as shown in the study, a narrow focus on crisis capacity may fail to address the many and complex challenges to providing high-quality care encountered by frontline medical workers during the COVID-19 pandemic.


For this qualitative study, the researchers interviewed 61 clinicians from across the U.S. in April and May 2020. These clinicians had cared for patients during the COVID-19 pandemic and/or had been involved in planning institutional responses to resource limitation.


Based on an inductive thematic analysis of interview transcripts, the researchers note these important findings:

  • Despite making plans for crisis capacity, clinicians encountered varied and sometimes unexpected forms of resource limitations that severely compromised care and required that they make difficult allocation decisions at the bedside.
  • To stretch existing resources, clinicians tried to develop alternative treatment options to provide at least some care to all in need.
  • Unprecedented challenges to caring for patients during the pandemic, including the need to limit in-person interactions, the rapid pace of change and the dearth of scientific evidence added to the challenges of caring for patients and communicating with families.

The study's findings, according to the researchers, underscored the complexity of providing high-quality care for patients during the COVID-19 pandemic. As such, the authors urge medical institutions to broaden the scope of systematic planning to address resource limitation challenges that can arise long before declarations of crisis capacity. Judicious use of resources will ensure that frontline clinicians can focus on providing optimum care in pandemic settings. 


Image credit: Morsa Images via iStock


Butler CR et al. (2020) US Clinicians’ Experiences and Perspectives on Resource Limitation and Patient Care During the COVID-19 Pandemic. JAMA Netw Open, 3(11):e2027315. doi:10.1001/jamanetworkopen.2020.27315

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