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Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors.

ABSTRACT: BACKGROUND:The coronavirus disease 2019 pandemic has or threatens to overwhelm health care systems. Many institutions are developing ventilator triage policies. OBJECTIVE:To characterize the development of ventilator triage policies and compare policy content. DESIGN:Survey and mixed-methods content analysis. SETTING:North American hospitals associated with members of the Association of Bioethics Program Directors. PARTICIPANTS:Program directors. MEASUREMENTS:Characteristics of institutions and policies, including triage criteria and triage committee membership. RESULTS:Sixty-seven program directors responded (response rate, 91.8%); 36 (53.7%) hospitals did not yet have a policy, and 7 (10.4%) hospitals' policies could not be shared. The 29 institutions providing policies were relatively evenly distributed among the 4 U.S. geographic regions (range, 5 to 9 policies per region). Among the 26 unique policies analyzed, 3 (11.3%) were produced by state health departments. The most frequently cited triage criteria were benefit (25 policies [96.2%]), need (14 [53.8%]), age (13 [50.0%]), conservation of resources (10 [38.5%]), and lottery (9 [34.6%]). Twenty-one (80.8%) policies use scoring systems, and 20 of these (95.2%) use a version of the Sequential Organ Failure Assessment score. Among the policies that specify the triage team's composition (23 [88.5%]), all require or recommend a physician member, 20 (87.0%) a nurse, 16 (69.6%) an ethicist, 8 (34.8%) a chaplain, and 8 (34.8%) a respiratory therapist. Thirteen (50.0% of all policies) require or recommend that those making triage decisions not be involved in direct patient care, but only 2 (7.7%) require that their decisions be blinded to ethically irrelevant considerations. LIMITATION:The results may not be generalizable to institutions without academic bioethics programs. CONCLUSION:Over one half of respondents did not have ventilator triage policies. Policies have substantial heterogeneity, and many omit guidance on fair implementation. PRIMARY FUNDING SOURCE:None.

SUBMITTER: Antommaria AHM

PROVIDER: S-EPMC7207244 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors.

Antommaria Armand H Matheny AHM Gibb Tyler S TS McGuire Amy L AL Wolpe Paul Root PR Wynia Matthew K MK Applewhite Megan K MK Caplan Arthur A Diekema Douglas S DS Hester D Micah DM Lehmann Lisa Soleymani LS McLeod-Sordjan Renee R Schiff Tamar T Tabor Holly K HK Wieten Sarah E SE Eberl Jason T JT

Annals of internal medicine 20200424 3

<h4>Background</h4>The coronavirus disease 2019 pandemic has or threatens to overwhelm health care systems. Many institutions are developing ventilator triage policies.<h4>Objective</h4>To characterize the development of ventilator triage policies and compare policy content.<h4>Design</h4>Survey and mixed-methods content analysis.<h4>Setting</h4>North American hospitals associated with members of the Association of Bioethics Program Directors.<h4>Participants</h4>Program directors.<h4>Measuremen ...[more]

PMID: 32330224

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Dataset Information

Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors.

Publications

Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors.

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