Patient Information Items Needed to Guide the Allocation of Scarce Life-Sustaining Resources: A Delphi Study of Multidisciplinary Experts
Patient Information Items Needed to Guide the Allocation of Scarce Life-Sustaining Resources: A Delphi Study of Multidisciplinary Experts
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DOI：
10.1017/dmp.2021.351
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发表时间：
2022-02-10
影响因子：
2.7
通讯作者：
Diekema, Douglas S.
中科院分区：
文献类型：
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作者：
Gray, Megan M.;Butler, Catherine R.;Diekema, Douglas S.
目的：2019冠状病毒病（COVID-19）大流行期间稀缺的维持生命资源的分配计划通常包括分诊团队，但缺乏操作细节，包括做出分诊决策需要哪些患者信息。方法：对华盛顿州防灾专家进行德尔菲研究，制定COVID-19大流行期间分诊团队决策所需的患者信息项目清单。在异步德尔菲回合中，专家们提出并评价他们与候选信息项目的一致程度。共识定义为>= 80%的同意。定性分析用于描述审议过程中产生的考虑。进行了定时仿真，以评估从电子健康记录中收集数据的可行性。结果：通过3轮非同步德尔菲，50位专家就患者年龄、重症或终末期合并症、入院原因及时间、急性呼吸衰竭措施、临床轨迹等24项患者信息达成共识。专家们权衡了有关信息项目如何支持有效的预测、一致性、准确性、最小化偏见和分诊过程的可操作性的复杂考虑。每位患者的数据收集时间中位数为227秒（四分位数范围为205,298）。结论：专家们就COVID-19大流行期间告知分诊团队所需和适当的患者信息项目达成了共识。
Objective: Plans for allocation of scarce life-sustaining resources during the coronavirus disease 2019 (COVID-19) pandemic often include triage teams, but operational details are lacking, including what patient information is needed to make triage decisions. Methods: A Delphi study among Washington state disaster preparedness experts was performed to develop a list of patient information items needed for triage team decision-making during the COVID-19 pandemic. Experts proposed and rated their agreement with candidate information items during asynchronous Delphi rounds. Consensus was defined as >= 80% agreement. Qualitative analysis was used to describe considerations arising in this deliberation. A timed simulation was performed to evaluate feasibility of data collection from the electronic health record. Results: Over 3 asynchronous Delphi rounds, 50 experts reached consensus on 24 patient information items, including patients' age, severe or end-stage comorbidities, the reason for and timing of admission, measures of acute respiratory failure, and clinical trajectory. Experts weighed complex considerations around how information items could support effective prognostication, consistency, accuracy, minimizing bias, and operationalizability of the triage process. Data collection took a median of 227 seconds (interquartile range = 205, 298) per patient. Conclusions: Experts achieved consensus on patient information items that were necessary and appropriate for informing triage teams during the COVID-19 pandemic.