[Using pandemic guidelines in simulated triage sessions. Preliminary observations and lessons learned]

In Spring 2020, the Netherlands appeared to be poorly prepared for 'code black': a situation in which Intensive Care Unit (ICU) bed shortage would be a reality. Guidelines were developed with medical and non-medical considerations for ICU triage. In recent months, we organized eight simulated triage sessions in four hospitals, as part of a research project. We asked triage teams to prioritize cases of patients in need of ICU care, aided by the guidelines. Data are still being analyzed; here we share some preliminary observations and lessons learned. In our sessions, it was striking how much triage depends on the input of the intensivist, especially when it comes to crucial expertise regarding prognosis and length of stay. Differences in prioritization predominantly depended on different estimations of prognosis and length of stay. The guidelines provide direction, but prioritizing ICU patients can be mentally burdensome for triagists. This requires support and aftercare for triage teams.