Perspectives of Triage Team Members Participating in Statewide Triage Simulations for Scarce Resource Allocation During the COVID-19 Pandemic in Washington State.
Perspectives of Triage Team Members Participating in Statewide Triage Simulations for Scarce Resource Allocation During the COVID-19 Pandemic in Washington State.
复制标题
DOI：
10.1001/jamanetworkopen.2022.7639
复制
发表时间：
2022-04-01
影响因子：
13.8
通讯作者：
Vranas, Kelly C.
中科院分区：
文献类型：
--
作者：
Butler, Catherine R.;Webster, Laura B.;Diekema, Douglas S.;Gray, Megan M.;Sakata, Vicki L.;Tonelli, Mark R.;Vranas, Kelly C.
本定性研究调查了在华盛顿州COVID-19大流行期间资源分配稀缺的情况下，参与全州卫生保健分诊模拟的分诊团队成员的经验主题。在COVID-19大流行期间，参与稀缺资源分诊小组的个人有什么经历？临床医生如何为这一角色做好准备？在这项对41名参与华盛顿州多机构分诊模拟的分诊团队成员的定性研究中，参与者描述了他们如何应对临床不确定性和伦理挑战，以及分诊任务如何与专业价值观相冲突，以及通常临床思维模式的转变。这些发现突出了分诊团队成员可能面临的挑战，并建议临床经验、分诊伦理和操作基础教育以及经验培训可以帮助他们为这一困难的角色做好准备。COVID-19大流行促使世界各地的卫生保健机构制定了在危机能力环境中分配稀缺资源的计划。这些计划往往依赖于快速部署机构分诊小组，这些小组将负责优先安排患者接受稀缺资源；然而，很少有人知道这些团队是如何运作的，或者如何支持团队成员参与这项独特的任务。确定主题，阐明分诊团队成员在分诊过程中的观点和经验。本定性研究采用归纳主题分析方法，对2020年12月至2021年2月COVID-19大流行期间华盛顿州分诊小组模拟的观察结果和对参与者的半结构化访谈进行了分析。参与者包括临床医生和伦理学分诊小组成员。数据分析时间为2020年12月至2021年11月。紧急主题描述分诊过程和分诊团队成员的经验。41名分诊小组成员（平均[SD]年龄50.3[11.4]岁，女性21[51.2%]）参加了12次模拟和21次随访访谈，其中亚裔5人（12.2%），白人35人（85.4%）；大多数参与者在城市医院工作（32人[78.0%]）。定性分析产生了三个相互关联的主题：(1)理解更广泛的资源分配方法：参与者努力理解分诊过程的操作和道德基础，这对于理解其团队的具体作用是必要的；(2)与不确定性作斗争：团队成员可能会发现很难或感到不负责任地根据有限的临床和情境患者信息做出相应的决定，他们会努力应对个别病例和整个分诊过程的伦理模糊特征；(3)转变心态：参与者努力理清关于患者生存可能性的狭隘决定，以摆脱内隐偏见和其他伦理相关因素，如生活质量。他们认为，团队开放的审议过程，以及在分诊方面的实践和个人经验，对于帮助他们重塑通常的认知方式，以配合这项独特的任务，都很重要。本研究发现，在稀缺资源分配的过程中，临床直觉和培训在适应独特角色方面存在挑战。这些发现表明，临床经验、分诊的伦理和操作基础教育以及分诊模拟等经验培训，可能有助于临床医生为这一困难的角色做好准备。
This qualitative study investigates themes in the experiences of triage team members participating in statewide simulations of health care triage under circumstances of scarce resource allocation during the COVID-19 pandemic in Washington State. What are the experiences of individuals participating in scarce resource triage teams during the COVID-19 pandemic, and how can clinicians prepare for this role? In this qualitative study of 41 triage team members participating in multi-institutional triage simulations in Washington state, participants described how they grappled with clinical uncertainty and ethical challenges and how the triage task could conflict with professional values and required transformation of the usual clinical mindset. These findings highlight challenges that triage team members may face and suggest that clinical experience, education in ethical and operational foundations of triage, and experiential training may help prepare them for this difficult role. The COVID-19 pandemic prompted health care institutions worldwide to develop plans for allocation of scarce resources in crisis capacity settings. These plans frequently rely on rapid deployment of institutional triage teams that would be responsible for prioritizing patients to receive scarce resources; however, little is known about how these teams function or how to support team members participating in this unique task. To identify themes illuminating triage team members’ perspectives and experiences pertaining to the triage process. This qualitative study was conducted using inductive thematic analysis of observations of Washington state triage team simulations and semistructured interviews with participants during the COVID-19 pandemic from December 2020 to February 2021. Participants included clinician and ethicist triage team members. Data were analyzed from December 2020 through November 2021. Emergent themes describing the triage process and experience of triage team members. Among 41 triage team members (mean [SD] age, 50.3 [11.4] years; 21 [51.2%] women) who participated in 12 simulations and 21 follow-up interviews, there were 5 Asian individuals (12.2%) and 35 White individuals (85.4%); most participants worked in urban hospital settings (32 individuals [78.0%]). Three interrelated themes emerged from qualitative analysis: (1) understanding the broader approach to resource allocation: participants strove to understand operational and ethical foundations of the triage process, which was necessary to appreciate their team’s specific role; (2) contending with uncertainty: team members could find it difficult or feel irresponsible making consequential decisions based on limited clinical and contextual patient information, and they grappled with ethically ambiguous features of individual cases and of the triage process as a whole; and (3) transforming mindset: participants struggled to disentangle narrow determinations about patients’ likelihood of survival to discharge from implicit biases and other ethically relevant factors, such as quality of life. They cited the team’s open deliberative process, as well as practice and personal experience with triage as important in helping to reshape their usual cognitive approach to align with this unique task. This study found that there were challenges in adapting clinical intuition and training to a distinctive role in the process of scarce resource allocation. These findings suggest that clinical experience, education in ethical and operational foundations of triage, and experiential training, such as triage simulations, may help prepare clinicians for this difficult role.
登录
查看更多内容
影响因子：
--
作者：
Butler CR;Webster LB;Sakata VL;Tonelli MR;Diekema DS;Gray MM
通讯作者：
Gray MM
影响因子：
39.2
作者：
Antommaria, Armand H. Matheny;Gibb, Tyler S.;Eberl, Jason T.
通讯作者：
Eberl, Jason T.
影响因子：
2.2
作者：
Gershon, Robyn R. M.;Vandelinde, Nikole;Prezant, David
通讯作者：
Prezant, David
影响因子：
120.7
作者：
Giacomini, MK;Cook, DJ
通讯作者：
Cook, DJ
影响因子：
2.7
作者：
Gray, Megan M.;Butler, Catherine R.;Diekema, Douglas S.
通讯作者：
Diekema, Douglas S.