Operationalization of critical care triage during a pandemic surge using protocolized communication and integrated supportive care

Abstract

Triage becomes necessary when demand for intensive care unit (ICU) resources exceeds supply. Without triage, there is a risk that patients will be admitted to the ICU in the sequence that they present, disadvantaging those who either present later or have poorer access to healthcare. Moreover, if the patients with the best prognosis are not allocated life support, there is the possibility that overall mortality will increase. Before formulating criteria, principles such as maximizing lives saved and fairness ought to have been agreed upon to guide decision-making. The triage process is subdivided into three parts, i.e., having explicit inclusion/exclusion criteria for ICU admission, prioritization of patients for allocation to available beds, and periodic reassessment of all patients already admitted to the ICU. Multidimensional criteria offer more holistic prognostication than only using age cutoffs. Appointed triage officers should also be enabled to make data-driven decisions. However, the process does not merely end with an allocation decision being made. Any decision has to be sensitively and transparently communicated to the patient and family. With infection control measures, there are challenges in managing communication and the psychosocial distress of dying alone. Therefore, explicit video call protocols and social services expertise will be necessary to mitigate these challenges. Besides symptom management and psychosocial management, supportive care teams play an integral role in coordination of complex cases. This scoping review found support for the three-pronged, triage-communicationsupportive care approach to facilitate the smooth operationalization of the triage process in a pandemic.

Inpatient generalist palliative care during the SARS-CoV-2 pandemic – experiences, challenges and potential solutions from the perspective of health care workers

“…Furthermore, emotions and compassion should be verbalized more strongly, since the non-verbal part of communication is partially or completely omitted by the (video)telephony [ 18 , 19 ]. The implementation and realization of clear communication concepts is also important in connection with prioritization decisions and to avoid overtherapy [ 19 , 20 ]. If scarce resources lead to prioritize decisions, a feeling of withholding care can arise, which can only be circumvented through comprehensible communication, for example, according to the "SHARE talking map" (specifically to explain resource allocation), as illustrated in Table 4 [ 21 ].…”

Inpatient Generalist Palliative Care During the SARS-CoV-2 Pandemic – Experiences, Challenges and Potential Solutions

“…Furthermore, emotions and compassion should be verbalized more strongly, since the non-verbal part of communication is partially or completely omitted by the (video)telephony [17,18]. The implementation and realization of clear communication concepts is also important in connection with prioritization decisions and to avoid overtherapy [18,19]. If scarce resources lead to prioritization decisions, a feeling of withholding of care can arise, which can only be circumvented through comprehensible communication, for example, according to the "SHARE talking map" (speci cally to explain resource allocation), as illustrated in Table 4 [20].…”

Development, Implementation, and User Evaluation of COVID-19 Dashboard in a Third-Level Hospital in Iran

“…The ignorance of users' views and their participation in designing such information systems has led to their lack of interest in such systems. 35,36 Therefore, the present study focused on the identification of the information needs and requirements of such a system from the users' point of view. Based on the study results, several methods were used to identify and extract indicators and requirements of the dashboard system which included investigation of similar information systems, user interviews, and questionnaires.…”

“…Therefore, patient triage is critical in situations like this since there is always a risk that patients may not be properly admitted to the ICU which may cause more harm and injury to the patients. 35 Regarding the fact that the triage, emergency, and ICU departments are involved in the process of providing health care services to COVID-19 patients, it is important to monitor the workflow of these units. Accordingly, the indicators required for COVID-19 management in the present study were identified through the assessment of the information needs of dashboard users.…”