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Triage Policies at U.S. Hospitals with Pediatric Intensive Care Units
Erica K Salter1, Jay R Malone2, Amanda Berg1
1Albert Gnaegi Center for Health Care Ethics, Saint Louis University, Saint Louis, Missouri, USA.
Insights
Many hospitals lack pediatric triage policies, but those with them increasingly use formal algorithms prioritizing mortality and age-appropriate scoring systems. Further research is needed to improve access and address disparities.
Area of Science:
- Pediatric critical care medicine
- Health policy analysis
- Healthcare quality improvement
Background:
- Pediatric triage policies are crucial for resource allocation in intensive care settings.
- Standardization of these policies is lacking across institutions.
- Understanding current practices is essential for developing evidence-based guidelines.
Purpose of the Study:
- To determine the prevalence of pediatric triage policies in U.S. hospitals.
- To analyze the content and components of existing pediatric triage policies.
Main Methods:
- Survey and solicitation of policies from U.S. hospitals with pediatric intensive care units.
- Qualitative analysis and coding of policies by two independent investigators.
Main Results:
- Only 28% of surveyed institutions had approved or draft pediatric triage policies.
- Policies commonly prioritized predicted mortality and utilized scoring systems like P-LogD2.
- Formal algorithms were present in 68% of policies, with random selection or life cycles as common tiebreakers.
Conclusions:
- A significant gap exists in the adoption of pediatric triage policies.
- Emerging trends show a move towards formal algorithms, mortality prediction, and age-specific scoring.
- Further research should focus on policy dissemination, scoring system validation, and health equity.
Objectives:
To characterize the prevalence and content of pediatric triage policies.
Methods:
We surveyed and solicited policies from U.S. hospitals with pediatric intensive care units. Policies were analyzed using qualitative methods and coded by 2 investigators.
Results:
Thirty-four of 120 institutions (28%) responded. Twenty-five (74%) were freestanding children's hospitals and 9 (26%) were hospitals within a hospital. Nine (26%) had approved policies, 9 (26%) had draft policies, 5 (14%) were developing policies, and 7 (20%) did not have policies. Nineteen (68%) institutions shared their approved or draft policy. Eight (42%) of those policies included neonates. The polices identified 0 to 5 (median 2) factors to prioritize patients. The most common factors were short- (17, 90%) and long- (14, 74%) term predicted mortality. Pediatric scoring systems included Pediatric Logistic Organ Dysfunction-2 (12, 63%) and Score for Neonatal Acute Physiology and Perinatal Extensions-II (4, 21%). Thirteen (68%) policies described a formal algorithm. The most common tiebreakers were random/lottery (10, 71%) and life cycles (9, 64%). The majority (15, 79%) of policies specified the roles of triage team members and 13 (68%) precluded those participating in patient care from making triage decisions.
Conclusions:
While many institutions still do not have pediatric triage policies, there appears to be a trend among those with policies to utilize a formal algorithm that focuses on short- and long-term predicted mortality and that incorporates age-appropriate scoring systems. Additional work is needed to expand access to pediatric-specific policies, to validate scoring systems, and to address health disparities.
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