Ventilator Triage Policies During the COVID-19 Pandemic at US Hospitals Associated With Members of the Association of Bioethics Program Directors

• Type of Material: Article
• Authors: Armand H. Matheny Antommaria, Cincinnati Children's Hospital Medical Center; Tyler S. Gibb, Western Michigan University; Amy L. McGuire, Baylor College of Medicine; Paul Wolpe, Emory University; Matthew K. Wynia, University of Colorado; Megan K. Applewhite, Albany Medical College; Arthur Caplan, New York University; Douglas S. Diekema, University of Washington; D. Micah Hester, University of Arkansas Medical Sciences; Lisa Soleymani Lehmann, VA New England Healthcare System; Renee McLeod-Sordjan, Northwell Health System; Tamar Schiff, New York University; Holly K. Tabor, Stanford University; Sarah E. Wieten, Stanford University; Jason T. Eberl, St. Louis University
• Language: English
• Date: 2020-08-04
• Publisher: AMER COLL PHYSICIANS
• Publication Version: Final Published Version
• Copyright Statement: © 2020 American College of Physicians
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.7326/M20-1738
• Title of Journal or Parent Work: ANNALS OF INTERNAL MEDICINE
• Volume: 173
• Issue: 3
• Start Page: 188
• End Page: +
• Keywords: ALLOCATION; Science & Technology; Medicine, General & Internal; Life Sciences & Biomedicine; General & Internal Medicine
• Research Categories: Health Sciences, Health Care Management; Biology, Virology

Abstract

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.None.