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Putting ICU triage guidelines into practice: A simulation study using observations and interviews.

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Dutch triage guidelines are feasible for intensive care unit (ICU) patient allocation during pandemics. However, team decision-making varied, highlighting the need for clear guidelines and practical training to ensure consistent and ethical patient prioritization.

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Area of Science:

  • Critical Care Medicine
  • Health Policy and Management

Background:

  • The COVID-19 pandemic necessitated national guidelines for intensive care unit (ICU) patient allocation when demand exceeds bed capacity.
  • This study investigates the practical application and challenges of ICU triage guidelines.

Purpose of the Study:

  • To explore triage teams' experiences using the Dutch triage guidelines for fictitious patients.
  • To identify factors influencing decision-making during ICU triage.

Main Methods:

  • Eight triage teams from four hospitals participated.
  • Fictitious patient cases were used for triage simulation.
  • Observations, audio recordings, and focus group interviews were conducted.
  • Data were analyzed using inductive content analysis.

Main Results:

  • The Dutch triage guidelines served as the primary decision-making basis.
  • Teams incorporated external considerations, sometimes deviating from guidelines to avoid non-medical criteria like age.
  • Group dynamics and individual opinions on guidelines influenced triage outcomes.
  • Intensivists often played a decisive role due to their expertise.

Conclusions:

  • The Dutch triage guidelines are implementable, but inconsistencies in patient prioritization were observed.
  • Guideline developers should refine criteria to prevent ethically questionable or inconsistent patient allocation.
  • Practical training on guideline application and rationale is recommended to improve adherence.