LAUSR

Hospitalization surges due to the ongoing pandemic required that my colleagues and I reduce bed use in the neurointensive care unit twice in the past year to make room for patients critically ill with COVID-19. Overwhelming demand for critical care services has highlighted the need to allocate services rationally and efficiently, but triage guidelines are broad and decisions are often subjective.1 Intensive care unit (ICU) bed availability varies widely among high-income economies from 3.6, 5.0, and 5.2 beds per 100,000 people in New Zealand, Ireland, and Japan to 25.8, 28.9, and 33.9 per 100,000 in the United States, Austria, and Germany, respectively.2 Hospital mortality and other important outcome metrics do not vary proportionally, and different norms for end of life care do not account for that magnitude of difference. Clearly, we have an opportunity to improve allocation of critical care services.