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

Area of Science:

• Critical Care Medicine
• Healthcare Management
• Medical Ethics

Background:

• The Netherlands faced potential Intensive Care Unit (ICU) bed shortages during the Spring 2020 'code black' scenario.
• Development of ICU triage guidelines incorporating medical and non-medical factors was initiated.
• Simulated triage exercises were conducted to evaluate preparedness and guideline effectiveness.

Purpose of the Study:

• To assess the practical application of ICU triage guidelines in simulated shortage scenarios.
• To identify key factors influencing patient prioritization during critical care resource limitations.
• To understand the psychological impact of triage decisions on healthcare professionals.

Main Methods:

• Eight simulated ICU triage sessions were conducted across four hospitals.
• Triage teams used developed guidelines to prioritize hypothetical patients requiring ICU admission.
• Data collection focused on decision-making processes, influencing factors, and team experiences.

Main Results:

• Intensivist input was crucial for prognosis and length of stay estimations, significantly impacting prioritization.
• Variations in patient prioritization were primarily due to differing estimations of prognosis and length of stay.
• While guidelines offered direction, the prioritization process was mentally burdensome for triage teams.

Conclusions:

• Simulated triage highlighted the indispensable role of intensivist expertise in critical care resource allocation.
• Effective ICU triage requires robust guidelines supported by clinical judgment, particularly regarding patient prognosis.
• Mental health support and aftercare are essential for healthcare professionals involved in high-stakes triage decisions.