Functionality of Scarce Healthcare Resource Triage Teams During the COVID-19 Pandemic: A Multi-Institutional Simulation Study.
Functionality of Scarce Healthcare Resource Triage Teams During the COVID-19 Pandemic: A Multi-Institutional Simulation Study.
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DOI：
10.1097/cce.0000000000000627
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发表时间：
2022-01
影响因子：
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通讯作者：
Gray MM
中科院分区：
文献类型：
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作者：
Butler CR;Webster LB;Sakata VL;Tonelli MR;Diekema DS;Gray MM
补充数字内容可在文本中找到。在COVID-19大流行期间分配稀缺医疗资源的计划通常涉及启动机构分流团队。这些小组将负责选择最有可能存活的患者，优先获得稀缺资源。然而，这一方法几乎没有经验支持。高保真分诊小组模拟研究。华盛顿州的医疗机构。分诊小组，由至少两名高级临床医生和一名生物伦理学家组成。参与者审查了危重患者不同样本的有限数量的去识别信息。然后，研究小组将每位患者分配到五个优先级类别中的一个，这五个优先级类别是由出院生存的可能性定义的。根据观察和参与者的反馈对这一过程进行了改进，之后进行了第二阶段的模拟。可行性是根据小组执行任务所需的时间来评估的。通过比较团队对出院生存可能性的预测与现实世界的出院结果来评估预后准确性。使用kappa统计评价了两组之间关于预后分类的一致性。于2020年12月至2021年2月进行了11次分流小组模拟（第一阶段8次，第二阶段3次）。总体而言，团队在每次会议中审查了23例患者病例的中位数（四分位数范围[IQR]，17-29），每个病例花费的中位数为102秒（IQR，50-268）。预期生存率和实际生存率之间的一致性为71%（IQR，64-76%）。两组患者预后分类的总体一致性为中等（加权kappa = 0.53）。这些研究结果支持潜在的可行性，准确性和有效性的机构分诊团队告知有限的一组患者信息项目的一部分，在医疗紧急情况下分配稀缺资源的战略。需要开展更多的工作来完善这一进程，使之适应当地情况。
Supplemental Digital Content is available in the text. Plans for allocating scarce healthcare resources during the COVID-19 pandemic commonly involve the activation of institutional triage teams. These teams would be responsible for selecting patients who are most likely to survive to be prioritized to receive scarce resources. However, there is little empirical support for this approach. High-fidelity triage-team simulation study. Healthcare institutions in Washington state. Triage teams, consisting of at least two senior clinicians and a bioethicist. Participants reviewed a limited amount of deidentified information for a diverse sample of critically ill patients. Teams then assigned each patient to one of five prioritization categories defined by likelihood of survival to hospital discharge. The process was refined based on observation and participant feedback after which a second phase of simulations was conducted. Feasibility was assessed by the time required for teams to perform their task. Prognostic accuracy was assessed by comparing teams’ prediction about likelihood of survival to hospital discharge with real-world discharge outcomes. Agreement between the teams on prognostic categorization was evaluated using kappa statistics. Eleven triage team simulations (eight in phase 1 and three in phase 2) were conducted from December 2020 to February 2021. Overall, teams reviewed a median of 23 patient cases in each session (interquartile range [IQR], 17–29) and spent a median of 102 seconds (IQR, 50–268) per case. The concordance between expected survival and real-world survival to discharge was 71% (IQR, 64–76%). The overall agreement between teams for placement of patients into prognostic categories was moderate (weighted kappa = 0.53). These findings support the potential feasibility, accuracy, and effectiveness of institutional triage teams informed by a limited set of patient information items as part of a strategy for allocating scarce resources in healthcare emergencies. Additional work is needed to refine the process and adapt it to local contexts.