Considerations for a Resource Allocation Framework for Intensive Care Units and Acute Care: A Qualitative Study Exploring the Experiences of Equity-Deserving Groups During the COVID-19 Demand Surge and Triage-Avoidant Strategies

Authors

  • Taylor Shorting Bruyère Health Research Institute, Ottawa, Ontario, Canada https://orcid.org/0000-0002-2781-9572
  • Jaya Rastogi Bruyère Health Research Institute, Ottawa, Ontario, Canada
  • Cécile M. Bensimon Bruyère Health Research Institute; Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada https://orcid.org/0009-0003-6699-9080
  • Alice Virani W. Maurice Young Centre for Applied Ethics, University of British Columbia, Vancouver, British Columbia, Canada https://orcid.org/0000-0003-1374-3172
  • Maxwell J. Smith School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada https://orcid.org/0000-0001-5230-0548
  • Simon Oczkowski Department of Medicine, McMaster University; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada https://orcid.org/0000-0002-2874-8948
  • Dianne Godkin Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada https://orcid.org/0009-0000-6237-1956
  • Marika Warren Department of Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada https://orcid.org/0000-0002-4548-4155
  • Sabira Valiani Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada https://orcid.org/0000-0001-5997-4115
  • Judy King Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada https://orcid.org/0000-0003-4530-9987
  • James Downar Bruyère Health Research Institute; Division of Palliative Care, Department of Medicine, University of Ottawa; Faculty of Medicine, University of Ottawa; Department of Critical Care, The Ottawa Hospital; Canadian Critical Care Society, Ottawa, Ontario, Canada https://orcid.org/0000-0001-7479-1560
  • Sarina R. Isenberg Bruyère Health Research Institute; Division of Palliative Care, Department of Medicine, University of Ottawa; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada https://orcid.org/0000-0001-6059-5366

DOI:

https://doi.org/10.7202/1126620ar

Keywords:

COVID-19, health equity, intensive care units, pandemic, public health ethics, public health emergency, resource allocation, triage

Language(s):

English

Abstract

During COVID-19, most intensive care units (ICUs) in Canada implemented strategies to manage a surge in demand for critical care to avoid turning people away, termed “triage-avoidant strategies.” These strategies, including redeploying non-ICU staff to the ICU to increase patient capacity, and transferring people over long distances to available beds, may have caused negative consequences for patients, healthcare staff, and equity-deserving groups. This study explores the perspectives of equity-deserving groups and organizations on triage-avoidant strategies during COVID-19, examined organization-specific responses, and identified system-level recommendations to improve equity, access, and preparedness. A qualitative descriptive study was conducted between July and December 2023 across five provinces in Canada. Participants, including staff from organizations serving equity-deserving groups, as well as government and healthcare representatives, were recruited through professional networks and snowball sampling. A semi-structured interview guide was used to elicit perspectives, which were then analyzed inductively using thematic analysis. 23 individuals from Ontario (n=12), British Columbia (n=4), Saskatchewan (n=4), Nova Scotia (n=2) and New Brunswick (n=1) participated. 15 participants (65%) identified as persons of colour or among equity-deserving groups; 13 (57%) participants worked within organizations representing decision-makers, clinicians, and/or equity-deserving groups. We identified three themes: 1) Triage-avoidant strategies were perceived to have disproportionately harmful effects on equity-deserving groups and healthcare providers; 2) organizations acted to mitigate effects of triage-avoidant strategies; and 3) various system-level actions could help mitigate the perceived effects of these strategies in future surges in demand. This study contributes to the literature by incorporating perspectives of representatives from diverse organizations and equity-deserving groups on how triage-avoidant strategies disproportionately harmed the populations they serve. Our findings can inform the development/implementation of triage-avoidant strategies that mitigate the perceived harmful effects on decision-makers, clinicians, and equity-deserving groups, while promoting equitable care.

Twenty-three individuals from Ontario (n=12), British Columbia (n=4), Saskatchewan (n=4), Nova Scotia (n=2) and New Brunswick (n=1) participated. Fifteen participants (65%) identified as persons of color or from systemically marginalized groups; thirteen (57%) participants worked within organizations representing decision-makers, clinicians, and/or systemically marginalized groups, such as race, illness, disability, socioeconomic factors or health status.

We identified three main themes relating to participants’ perspectives of triage-avoidant strategies: Triage-avoidant strategies had disproportionately harmful impacts on systemically marginalized populations and healthcare providers; organizations acted to mitigate effects of triage-avoidant strategies; and, various system-level actions could help mitigate the perceived effects of these strategies in the future.

Findings can inform the development and implementation of triage or triage-avoidant strategies that may mitigate the perceived harmful effects of such strategies on decision-makers, clinicians, and/or systemically marginalized groups, and promote equitable care.

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© Han Han Li

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Published

2026-06-22

How to Cite

[1]
Shorting T, Rastogi J, Bensimon CM, Virani A, Smith MJ, Oczkowski S, et al. Considerations for a Resource Allocation Framework for Intensive Care Units and Acute Care: A Qualitative Study Exploring the Experiences of Equity-Deserving Groups During the COVID-19 Demand Surge and Triage-Avoidant Strategies. Can. J. Bioeth 2026;9:67-78. https://doi.org/10.7202/1126620ar.

Issue

Vol. 9 No. 3 (2026): Open Issue

Section

Articles

License

Copyright (c) 2026 Taylor Shorting, Jaya Rastogi, Cécile M. Bensimon, Alice Virani, Maxwell J. Smith, Simon Oczkowski, Dianne Godkin, Marika Warren, Sabira Valiani , Judy King, James Downar, Sarina R. Isenberg

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