Withholding and withdrawing of the treatment for major surge in coronavirus disease 2019 (COVID-19) pandemic, from the viewpoint of healthcare resource rationing

Sawamura, Tadashi; Norisue, Yasuhiro; Mima, Hiroyuki; Ueta, Ikuya; Ohno, Mika; Maki, Jun; Ito, Kaori; Uemura, Sakura; Uesawa, Hiromi; Gando, Satoshi; Fujino, Yuji; Nishida, Osamu

doi:10.3918/jsicm.27_509

Cited by 4 publications

(3 citation statements)

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“…Reasons for the lack of discussion include the general uncomfortableness surrounding discussion concerning death and the lack of daily clinical issue discussions by hospital ethics committees (Ikka, 2013; Norisue et al, 2021; Seino et al, 2022). The absence of national guidelines and consensus regarding triage during the pandemic—only the availability of ventilator allocation guidelines released by professional medical organizations—has limited public understanding of the actual triage process and decisions made by frontline workers (Sawamura et al, 2020). Given this background, we conducted a study to identify the actual decision-making processes and decisions regarding COVID-19 patient ICU admission and mechanical ventilator allocation by frontline medical providers, as well as issues associated with the processes.…”

Section: Introductionmentioning

confidence: 99%

Patient Admission and Mechanical Ventilator Allocation Decision-Making Processes by Frontline Medical Professionals in a Japanese ICU During the COVID-19 Pandemic: A Qualitative Study

Ishizaki,

Jindai,

Saito

et al. 2023

Qual Health Res

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During the COVID-19 pandemic, the need to triage COVID-19 patients in ICUs emerged globally. Triage guidelines were established in many countries; however, the actual triage decision-making processes and decisions themselves made by frontline medical providers may not have exactly reflected those guidelines. Despite the need to understand decisions and processes in practice regarding patient ICU admission and mechanical ventilator usage to identify areas of improvement for medical care provision, such research is limited. This qualitative study was conducted to identify the decision-making processes regarding COVID-19 patient ICU admissions and mechanical ventilator allocation by frontline medical providers and issues associated with those processes in an ICU during the COVID-19 pandemic. Semi-structured, in-depth interviews were conducted with ICU physicians and nurses working at an urban tertiary referral hospital in Japan between February and April 2022. Patient characteristics that influenced triage decisions made by physicians and the interaction between physicians, nurses, and senior management staff upon making such decisions are discussed in this article. An implicated issue was the lack of legal support for Japanese physicians to practice withdrawal of life-sustaining treatments even during emergencies. Another issue was the impact of non-clinical forces—likely specific to health emergencies—on physicians’ decisions regarding mechanical ventilator allocation, where such forces imposed a significant mental burden on the medical providers. We consider public policy and legal implications for future pandemics.

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Section: Introductionmentioning

confidence: 99%

Patient Admission and Mechanical Ventilator Allocation Decision-Making Processes by Frontline Medical Professionals in a Japanese ICU During the COVID-19 Pandemic: A Qualitative Study

Ishizaki,

Jindai,

Saito

et al. 2023

Qual Health Res

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“…6,7 Currently, Japan has about five ICU beds per 100,000 population, which is fewer than most other developed countries [8][9][10][11][12] ; thus, most clinicians and policymakers in Japan consider the country's supply of beds for critically ill patients to be insufficient to meet demand-both under the normal conditions of temporal variation and in a disaster situation. 13 However, there have been limited data to guide planning for critical care utilization in Japan. Data on ICU occupancy and on the occupancy of high care units (HCUs)-a potential alternative to ICUs-are lacking.…”

Section: Introductionmentioning

confidence: 99%

“… 6 , 7 Currently, Japan has about five ICU beds per 100,000 population, which is fewer than most other developed countries 8 – 12 ; thus, most clinicians and policymakers in Japan consider the country’s supply of beds for critically ill patients to be insufficient to meet demand—both under the normal conditions of temporal variation and in a disaster situation. 13 …”

Section: Introductionmentioning

confidence: 99%

Intensive Care Unit Occupancy in Japan, 2015–2018: A Nationwide Inpatient Database Study

Ohbe

Sasabuchi

Kumazawa

et al. 2022

Journal of Epidemiology

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Background: Detailed data on intensive care unit (ICU) occupancy in Japan are lacking. Using a nationwide inpatient database in Japan, we aimed to assess ICU bed occupancy to guide critical care utilization planning. Methods: We identified all ICU patients admitted from January 1, 2015 to December 31, 2018 to ICU-equipped hospitals participating in the Japanese Diagnosis Procedure Combination inpatient database. We assessed the trends in daily occupancy by counting the total number of occupied ICU beds on a given day divided by the total number of licensed ICU beds in the participating hospitals. We also assessed ICU occupancy for patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies. Results: Over the 4 study years, 1,379,618 ICU patients were admitted to 495 hospitals equipped with 5,341 ICU beds, accounting for 75% of all ICU beds in Japan. Mean ICU occupancy on any given day was 60%, with a range of 45.0% to 72.5%. Mean ICU occupancy did not change over the 4 years. Mean ICU occupancy was about 9% higher on weekdays than on weekends and about 5% higher in the coldest season than in the warmest season. For patients with mechanical ventilation, patients with extracorporeal membrane oxygenation, and patients without life-supportive therapies, mean ICU occupancy was 24%, 0.5%, and 30%, respectively. Conclusion: Only one-fourth of ICU beds were occupied by mechanically ventilated patients, suggesting that the critical care system in Japan has substantial surge capacity under normal temporal variation to care for critically ill patients.

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Therapeutic Misconception as the Basis for Vaccine Nationalism of Japan: A Historical Reflection and Perspectives for Global Public Health

Kurihara,

Saio

2023

Ethical Innovation for Global Health

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Withholding and withdrawing of the treatment for major surge in coronavirus disease 2019 (COVID-19) pandemic, from the viewpoint of healthcare resource rationing

Cited by 4 publications

References 0 publications

Patient Admission and Mechanical Ventilator Allocation Decision-Making Processes by Frontline Medical Professionals in a Japanese ICU During the COVID-19 Pandemic: A Qualitative Study

Patient Admission and Mechanical Ventilator Allocation Decision-Making Processes by Frontline Medical Professionals in a Japanese ICU During the COVID-19 Pandemic: A Qualitative Study

Intensive Care Unit Occupancy in Japan, 2015–2018: A Nationwide Inpatient Database Study

Therapeutic Misconception as the Basis for Vaccine Nationalism of Japan: A Historical Reflection and Perspectives for Global Public Health

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