Ventilator Triage Policies During the COVID-19 Pandemic at US Hospitals Associated With Members of the Association of Bioethics Program Directors
Ventilator Triage Policies During the COVID-19 Pandemic at US Hospitals Associated With Members of the Association of Bioethics Program Directors
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DOI：
10.7326/m20-1738
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发表时间：
2020-08-04
影响因子：
39.2
通讯作者：
Eberl, Jason T.
中科院分区：
文献类型：
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作者：
Antommaria, Armand H. Matheny;Gibb, Tyler S.;Eberl, Jason T.
背景：2019年冠状病毒病大流行已经或可能使卫生保健系统不堪重负。许多机构正在制定呼吸机分诊政策。目的：探讨呼吸机分诊政策的发展特点，并对政策内容进行比较。设计：调查和混合方法内容分析。环境：北美医院与生物伦理项目主任协会成员有关。参与者：项目主管。衡量标准：机构和政策的特点，包括分类标准和分类委员会成员。结果：有67位项目主任回复（回复率91.8%）；36家（53.7%）医院没有政策，7家（10.4%）医院的政策不能共享。提供政策的29个机构相对均匀地分布在美国的4个地理区域（范围，每个区域5到9个政策）。在分析的26项独特政策中，有3项（11.3%）是由州卫生部门制定的。最常被引用的分类标准是福利（25份保单[96.2%]）、需求（14份[53.8%]）、年龄（13份[50.0%]）、资源保护（10份[38.5%]）和彩票（9份[34.6%]）。21项（80.8%）政策使用评分系统，其中20项（95.2%）使用序贯器官衰竭评估评分。在规定分诊小组组成的政策中（23份[88.5%]），所有政策都要求或推荐一名医生成员，20份（87.0%）为护士，16份（69.6%）为伦理学家，8份（34.8%）为牧师，8份（34.8%）为呼吸治疗师。13项（占所有政策的50.0%）要求或建议那些做出分诊决定的人不参与直接的病人护理，但只有2项（7.7%）要求他们的决定不考虑与伦理无关的考虑。局限性：结果可能不能推广到没有学术生物伦理学项目的机构。结论：超过一半的受访者没有呼吸机分诊政策。政策存在很大的异质性，许多政策忽略了公平执行的指导。
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.