Functionality of Scarce Healthcare Resource Triage Teams During the COVID-19 Pandemic: A Multi-Institutional Simulation Study

Butler, Catherine R.; Webster, Laura; Sakata, Vicki L.; Tonelli, Mark R.; Diekema, Douglas S.; Gray, Megan

doi:10.1097/cce.0000000000000627

Cited by 6 publications

(9 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…22 Second, we held multi-institutional triage team simulations to evaluate efficiency, consistency, and effectiveness of the approach. 23 Third, we conducted a qualitative study of the triage team process and experiences of team members. In this report, we describe the results of this third component of the research program.…”

Section: Methodsmentioning

confidence: 99%

“…First, we conducted a Delphi study of emergency preparedness experts to develop a list of patient information items needed to inform triage team decision-making . Second, we held multi-institutional triage team simulations to evaluate efficiency, consistency, and effectiveness of the approach . Third, we conducted a qualitative study of the triage team process and experiences of team members.…”

Section: Methodsmentioning

confidence: 99%

“…As previously described, clinicians and ethicists involved in Washington state institutional emergency preparation participated in triage team simulations from December 2020 to February 2021. Triage teams consisted of at least 2 clinicians (physicians and nurses) and a team member with formal training in bioethics or experience in clinical ethics consultation .…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Perspectives of Triage Team Members Participating in Statewide Triage Simulations for Scarce Resource Allocation During the COVID-19 Pandemic in Washington State

et al. 2022

Self Cite

View full text Add to dashboard Cite

IMPORTANCEThe COVID-19 pandemic prompted health care institutions worldwide to develop plans for allocation of scarce resources in crisis capacity settings. These plans frequently rely on rapid deployment of institutional triage teams that would be responsible for prioritizing patients to receive scarce resources; however, little is known about how these teams function or how to support team members participating in this unique task. OBJECTIVETo identify themes illuminating triage team members' perspectives and experiences pertaining to the triage process. DESIGN, SETTING, AND PARTICIPANTS This qualitative study was conducted using inductive thematic analysis of observations of Washington state triage team simulations and semistructured interviews with participants during the COVID-19 pandemic from December 2020 to February 2021. Participants included clinician and ethicist triage team members. Data were analyzed from December 2020 through November 2021. MAIN OUTCOMES AND MEASURES Emergent themes describing the triage process and experience of triage team members. RESULTS Among 41 triage team members (mean [SD] age, 50.3 [11.4] years; 21 [51.2%] women) who participated in 12 simulations and 21 follow-up interviews, there were 5 Asian individuals (12.2%) and 35 White individuals (85.4%); most participants worked in urban hospital settings (32 individuals [78.0%]). Three interrelated themes emerged from qualitative analysis: (1) understanding the broader approach to resource allocation: participants strove to understand operational and ethical foundations of the triage process, which was necessary to appreciate their team's specific role; (2) contending with uncertainty: team members could find it difficult or feel irresponsible making consequential decisions based on limited clinical and contextual patient information, and they grappled with ethically ambiguous features of individual cases and of the triage process as a whole; and (3) transforming mindset: participants struggled to disentangle narrow determinations about patients' likelihood of survival to discharge from implicit biases and other ethically relevant factors, such as quality of life. They cited the team's open deliberative process, as well as practice and personal experience with triage as important in helping to reshape their usual cognitive approach to align with this unique task. CONCLUSIONS AND RELEVANCE This study found that there were challenges in adapting clinical intuition and training to a distinctive role in the process of scarce resource allocation. These findings (continued) Key Points Question What are the experiences of individuals participating in scarce resource triage teams during the COVID-19 pandemic, and how can clinicians prepare for this role? Findings In this qualitative study of 41 triage team members participating in multi-institutional triage simulations in Washington state, participants described how they grappled with clinical uncertainty and ethical challenges and how the triage task could conflict with professional val...

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Perspectives of Triage Team Members Participating in Statewide Triage Simulations for Scarce Resource Allocation During the COVID-19 Pandemic in Washington State

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although no formal data has been published examining the impact of these protocols, several simulations have been run to understand the impact these protocols may have on equity. 8 The simulations used triage algorithms commonly outlined in CSC protocols that assign points based on the Sequential Organ Failure Assessment (SOFA) score and chronic co-morbidities that intended to estimate one- and five-year mortality, where higher SOFA scores predict increased risk of mortality. Black patients have higher SOFA scores despite no difference in mortality or ICU admission rates.…”

Section: Introductionmentioning

confidence: 99%

“Community engagement via restorative justice to build equity-oriented crisis standards of care”

Long

Manchanda

Dekker

et al. 2022

Journal of the National Medical Association

View full text Add to dashboard Cite

“…Triage concepts across the world differ, for example, in defining exclusion criteria for treatment and/or implementing triage officers (9). Several studies have already proved feasibility and accuracy of allocation concepts, but there are still many unresolved questions about how to predict short-term survival best, how to mitigate risks of biases or limitations of scores, and how to implement the fairest (re-)allocation (10)(11)(12).…”

mentioning

confidence: 99%

Preparing for the Worst-Case Scenario in a Pandemic: Intensivists Simulate Prioritization and Triage of Scarce ICU Resources*

Knochel

Adaktylos-Surber

Schmolke

et al. 2022

Critical Care Medicine

View full text Add to dashboard Cite

OBJECTIVES: Simulation and evaluation of a prioritization protocol at a German university hospital using a convergent parallel mixed methods design. DESIGN: Prospective single-center cohort study with a quantitative analysis of ICU patients and qualitative content analysis of two focus groups with intensivists. SETTING: Five ICUs of internal medicine and anesthesiology at a German university hospital. PATIENTS: Adult critically ill ICU patients ( n = 53). INTERVENTIONS: After training the attending senior ICU physicians ( n = 13) in rationing, an impending ICU congestion was simulated. All ICU patients were rated according to their likelihood to survive their acute illness (good-moderate-unfavorable). From each ICU, the two patients with the most unfavorable prognosis ( n = 10) were evaluated by five prioritization teams for triage. MEASUREMENTS AND MAIN RESULTS: Patients nominated for prioritization visit ( n = 10) had higher Sequential Organ Failure Assessment scores and already a longer stay at the hospital and on the ICU compared with the other patients. The order within this worst prognosis group was not congruent between the five teams. However, an in-hospital mortality of 80% confirmed the reasonable match with the lowest predicted probability of survival. Qualitative data highlighted the tremendous burden of triage and the need for a team-based consensus-oriented decision-making approach to ensure best possible care and to support professionals. Transparent communication within the teams, the hospital, and to the public was seen as essential for prioritization implementation. CONCLUSIONS: To mitigate potential bias and to reduce the emotional burden of triage, a consensus-oriented, interdisciplinary, and collaborative approach should be implemented. Prognostic comparative assessment by intensivists is feasible. The combination of long-term ICU stay and consistently high Sequential Organ Failure Assessment scores resulted in a greater risk for triage in patients. It remains challenging to reliably differentiate between patients with very low chances to survive and requires further conceptual and empirical research.

show abstract

Functionality of Scarce Healthcare Resource Triage Teams During the COVID-19 Pandemic: A Multi-Institutional Simulation Study

Abstract: Supplemental Digital Content is available in the text.

Cited by 6 publications

References 32 publications

Perspectives of Triage Team Members Participating in Statewide Triage Simulations for Scarce Resource Allocation During the COVID-19 Pandemic in Washington State

Perspectives of Triage Team Members Participating in Statewide Triage Simulations for Scarce Resource Allocation During the COVID-19 Pandemic in Washington State

“Community engagement via restorative justice to build equity-oriented crisis standards of care”

Preparing for the Worst-Case Scenario in a Pandemic: Intensivists Simulate Prioritization and Triage of Scarce ICU Resources*

Contact Info

Product

Resources

About