Intensive Care Admission Triage during a Pandemic: A Survey of the Acceptability of Triage Tools

Abstract

We conducted a survey of the UK Intensive Care Society regarding physician opinion of national guidance on ICU triage during a viral pandemic. Respondents graded agreement for seventeen triage criteria, ten from the Department of Health. We determined whether respondents accepted the whole tool on the basis of proportion of criteria agreed with. A modified tool was devised and acceptability compared. Five hundred and fifty questionnaires were returned (33.1% from senior physicians). Approximately half of senior physicians (49.5%) and 44.4% of other respondents found the tool acceptable. This improved to 68.7% and 59.2% for the modified tool. Chi-square analysis revealed no statistically significant difference between the opinions of senior physicians and other respondents (p=0.850 for the original tool, p=0.593 for the modified tool). A small change to the government guidelines produced a tool with improved acceptability among ICU physicians.

Keywords

triage pandemic critical care influenza human healthcare rationing

References

Christian

Hawryluck

Wax

. Development of a triage protocol for critical care during an influenza pandemic. CMAJ 2006;175: 1377–81.

Department of Health Pandemic Influenza Preparedness Team. Pandemic influenza - Guidance on preparing acute hospitals in England. (Online) November 2007. Available from: www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_080727.pdf Accessed 5th September 2010.

Department of Health Pandemic Influenza Preparedness Team. Pandemic Flu - Management of demand and capacity in healthcare organisations (Surge). (Online) 13 Apr 2010. Available from: www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_098750.pdf Accessed 5th September 2010.

Department of Health Pandemic Influenza Preparedness Team. Pandemic Flu – A national framework for responding to an influenza pandemic. (Online) November 2007. Available from: www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_080745.pdf Accessed 5th September 2010.

Rubinson

Hick

Hanfling

. Definitive care for the critically ill during a disaster: a framework for optimizing critical care surge capacity from a task force for mass critical care summit meeting, 26–27th January 2007, Chicago, IL. Chest 2008;133 (Suppl 5):18S–31S.

Talmor

Jones

Rubinson

. Simple triage scoring system predicting death and the need for critical care resources for use during epidemics Crit Care Med 2007;35: 1251–56.

Menon

Taylor

Ridley

. Modelling the impact of an influenza pandemic on critical care services in England. Anaesthesia 2005;60: 952–54.

Ercole

Menon

O'Donnell

. Modelling the impact of pandemic influenza A(H1N1) on UK paediatric intensive care demand. Arch Dis Child 2009;94: 962–64.

Challen

Bentley

Bright

. Clinical review: Mass casualty triage – pandemic influenza and critical care. Crit Care 2007;11: 212–18.

10.

Office of National Statistics UK 2001 Census. Focus on Religion. (Online). Available from: www.statistics.gov.uk/downloads/theme_compendia/for2004/FocusonReligion.pdf Accessed 6th November 2011.

11.

Eastman

Philips

Rhodes

. Triaging for adult critical care in the event of overwhelming need. Intensive Care Med 2010;36: 1076–82.

12.

Tillyard

. Re-organising the pandemic triage processes to ethically maximisie individuals' best interests. Intensive Care Med 2010;36: 1966–71.

13.

Khan

Hulme

Sherwood

. Assessment of the validity of SOFA score based triage in H1N1 critically ill patients during an influenza pandemic. Anaesthesia 2009;64: 1283–88.

14.

Guest

Tantam

Donlin

. An observational cohort study of triage for critical care provision during pandemic influenza: ‘clipboard physicians’ or ‘evidenced based medicine’? Anaesthesia 2009;64: 1199–206.

15.

Christian

Hamielec

Lazar

. A retrospective cohort pilot study to evaluate a triage tool for use in a pandemic. Crit Care 2009;13: R170–79.

16.

Singer

Benatar

Bernstein

. Ethics and SARS: lessons from Toronto. BMJ 2003;327: 1342–44.

17.

Vincent

Moreno

Takala

. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22: 707–01.