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The good, the bad and the ugly: pandemic priority decisions and triage
In this analysis we discuss the change in criteria for triage of patients during three different phases of a pandemic like COVID-19, seen from the critical care point of view. Availability of critical care beds has become a hot topic, and in many countries, we have seen a huge increase in the provis...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299641/ https://www.ncbi.nlm.nih.gov/pubmed/32522814 http://dx.doi.org/10.1136/medethics-2020-106489 |
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author | Flaatten, Hans Van Heerden, Vernon Jung, Christian Beil, Michael Leaver, Susannah Rhodes, Andrew Guidet, Bertrand deLange, Dylan W |
author_facet | Flaatten, Hans Van Heerden, Vernon Jung, Christian Beil, Michael Leaver, Susannah Rhodes, Andrew Guidet, Bertrand deLange, Dylan W |
author_sort | Flaatten, Hans |
collection | PubMed |
description | In this analysis we discuss the change in criteria for triage of patients during three different phases of a pandemic like COVID-19, seen from the critical care point of view. Availability of critical care beds has become a hot topic, and in many countries, we have seen a huge increase in the provision of temporary intensive care bed capacity. However, there is a limit where the hospitals may run out of resources to provide critical care, which is heavily dependent on trained staff, just-in-time supply chains for clinical consumables and drugs and advanced equipment. In the first (good) phase, we can still do clinical prioritisation and decision-making as usual, based on the need for intensive care and prognostication: what are the odds for a good result with regard to survival and quality of life. In the next (bad phase), the resources are mostly available, but the system is stressed by many patients arriving over a short time period and auxiliary beds in different places in the hospital being used. We may have to abandon admittance of patients with doubtful prognosis. In the last (ugly) phase, usual medical triage and priority setting may not be sufficient to decrease inflow and there may not be enough intensive care unit beds available. In this phase different criteria must be applied using a utilitarian approach for triage. We argue that this is an important transition where society, and not physicians, must provide guidance to support triage that is no longer based on medical priorities alone. |
format | Online Article Text |
id | pubmed-7299641 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-72996412020-06-23 The good, the bad and the ugly: pandemic priority decisions and triage Flaatten, Hans Van Heerden, Vernon Jung, Christian Beil, Michael Leaver, Susannah Rhodes, Andrew Guidet, Bertrand deLange, Dylan W J Med Ethics Current Controversy In this analysis we discuss the change in criteria for triage of patients during three different phases of a pandemic like COVID-19, seen from the critical care point of view. Availability of critical care beds has become a hot topic, and in many countries, we have seen a huge increase in the provision of temporary intensive care bed capacity. However, there is a limit where the hospitals may run out of resources to provide critical care, which is heavily dependent on trained staff, just-in-time supply chains for clinical consumables and drugs and advanced equipment. In the first (good) phase, we can still do clinical prioritisation and decision-making as usual, based on the need for intensive care and prognostication: what are the odds for a good result with regard to survival and quality of life. In the next (bad phase), the resources are mostly available, but the system is stressed by many patients arriving over a short time period and auxiliary beds in different places in the hospital being used. We may have to abandon admittance of patients with doubtful prognosis. In the last (ugly) phase, usual medical triage and priority setting may not be sufficient to decrease inflow and there may not be enough intensive care unit beds available. In this phase different criteria must be applied using a utilitarian approach for triage. We argue that this is an important transition where society, and not physicians, must provide guidance to support triage that is no longer based on medical priorities alone. BMJ Publishing Group 2021-12 2020-06-10 /pmc/articles/PMC7299641/ /pubmed/32522814 http://dx.doi.org/10.1136/medethics-2020-106489 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Current Controversy Flaatten, Hans Van Heerden, Vernon Jung, Christian Beil, Michael Leaver, Susannah Rhodes, Andrew Guidet, Bertrand deLange, Dylan W The good, the bad and the ugly: pandemic priority decisions and triage |
title | The good, the bad and the ugly: pandemic priority decisions and triage |
title_full | The good, the bad and the ugly: pandemic priority decisions and triage |
title_fullStr | The good, the bad and the ugly: pandemic priority decisions and triage |
title_full_unstemmed | The good, the bad and the ugly: pandemic priority decisions and triage |
title_short | The good, the bad and the ugly: pandemic priority decisions and triage |
title_sort | good, the bad and the ugly: pandemic priority decisions and triage |
topic | Current Controversy |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299641/ https://www.ncbi.nlm.nih.gov/pubmed/32522814 http://dx.doi.org/10.1136/medethics-2020-106489 |
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