The Frailty of Disability: A Controversial Triage Criterion

Hortal-Carmona, Joaquín; Liedo, Belén; Rueda, Jon; Caballero, Rosana Triviño

doi:10.1080/15265161.2021.1980140

Cited by 2 publications

(2 citation statements)

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“…In two teams this argument impacted the prioritization. However, the Dutch guidelines [15,16], as well as the guidelines of many other countries and international literature [10,19,[25][26][27][28], argue that patients should be considered equally in triage, irrespective of potential disabilities that do not impact chance of short term survival. While taking time to wean from the ventilator technically falls within the scope of the Dutch ICU triage guidelines, this consideration is at odds with the principle of equality as described in the guidelines.…”

Section: Inconsistencies In the Application Of The Dutch Icu Triage G...mentioning

confidence: 99%

Putting ICU triage guidelines into practice: A simulation study using observations and interviews

Abma,

Olthuis,

Maassen

et al. 2023

PLoS ONE

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Background The COVID-19 pandemic has prompted many countries to formulate guidelines on how to deal with a worst-case scenario in which the number of patients needing intensive care unit (ICU) care exceeds the number of available beds. This study aims to explore the experiences of triage teams when triaging fictitious patients with the Dutch triage guidelines. It provides an overview of the factors that influence decision-making when performing ICU triage with triage guidelines. Methods Eight triage teams from four hospitals were given files of fictitious patients needing intensive care and instructed to triage these patients. Sessions were observed and audio-recorded. Four focus group interviews with triage team members were held to reflect on the sessions and the Dutch guidelines. The results were analyzed by inductive content analysis. Results The Dutch triage guidelines were the main basis for making triage decisions. However, some teams also allowed their own considerations (outside of the guidelines) to play a role when making triage decisions, for example to help avoid using non-medical criteria such as prioritization based on age group. Group processes also played a role in decision-making: triage choices can be influenced by the triagists’ opinion on the guidelines and the carefulness with which they are applied. Intensivists, being most experienced in prognostication of critical illness, often had the most decisive role during triage sessions. Conclusions Using the Dutch triage guidelines is feasible, but there were some inconsistencies in prioritization between teams that may be undesirable. ICU triage guideline writers should consider which aspects of their criteria might, when applied in practice, lead to inconsistencies or ethically questionable prioritization of patients. Practical training of triage team members in applying the guidelines, including explanation of the rationale underlying the triage criteria, might improve the willingness and ability of triage teams to follow the guidelines closely.

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Section: Inconsistencies In the Application Of The Dutch Icu Triage G...mentioning

confidence: 99%

Putting ICU triage guidelines into practice: A simulation study using observations and interviews

Abma,

Olthuis,

Maassen

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…reasons. (Atkins and Das 2021; Batra and Latham 2021;Hortal et al 2021; McGreevy and Rhodes 2021; Reynolds et al 2021) As I argued previously, health systems should be clear about their ethical rationale for triage and allocation of treatment to allow open debate within the wider community,…”

mentioning

confidence: 99%

Dementia, Frailty and Triage in a Pandemic

Wilkinson

2021

The American Journal of Bioethics

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The Frailty of Disability: A Controversial Triage Criterion

Cited by 2 publications

References 9 publications

Putting ICU triage guidelines into practice: A simulation study using observations and interviews

Putting ICU triage guidelines into practice: A simulation study using observations and interviews

Dementia, Frailty and Triage in a Pandemic

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