ArticleJournal of medical ethics2020
The good, the bad and the ugly: pandemic priority decisions and triage.
Article in Journal of medical ethics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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Who cites it
27 citing papers in PubMed.
- A temporary hospital intensive care unit: a preparedness concept to increase intensive care capacity.Scandinavian journal of trauma, resuscitation and emergency medicine · 2024Article
- Identifying health and healthcare priorities in rural areas: A concept mapping study informed by consumers, health professionals and researchers.Health research policy and systems · 2024Article
- Wastewater-based surveillance as a tool for public health action: SARS-CoV-2 and beyond.Clinical microbiology reviews · 2024Review
- The trajectory of very old critically ill patients.Intensive care medicine · 2024Review
- Cross-cultural adaptation of the FRAIL scale for critically ill patients in Spain.Nursing open · 2023Article
- Change in Code Status Orders of Hospitalized Adults With COVID-19 Throughout the Pandemic: A Retrospective Cohort Study.Journal of palliative medicine · 2023Article
- Perceptions and concerns of emergency medicine practitioners about artificial intelligence in emergency triage management during the pandemic: a national survey-based study.Frontiers in public health · 2023Article
- Priority setting for pandemic preparedness and response: A comparative analysis of COVID-19 pandemic plans in 12 countries in the Eastern Mediterranean Region.Health policy OPEN · 2022Review
- How German and Italian Laypeople Reason about Distributive Shortages during COVID-19.International journal of environmental research and public health · 2022Article
- Variations in end-of-life care practices in older critically ill patients with COVID-19 in Europe.Journal of internal medicine · 2022Article
- Who gets the ventilator? A multicentre survey of intensivists' opinions of triage during the first wave of the COVID-19 pandemic.Acta anaesthesiologica Scandinavica · 2022Article
- Comment on: Rethinking ICU readmission and timelimited trial in the contingency capacity.Journal of critical care · 2022Article
- Increased 30-day mortality in very old ICU patients with COVID-19 compared to patients with respiratory failure without COVID-19.Intensive care medicine · 2022Article
- The Impact of Age on In-Hospital Mortality in Critically Ill COVID-19 Patients: A Retrospective and Multicenter Study.Diagnostics (Basel, Switzerland) · 2022Article
- Predictors of Delayed Recognition of Critical Illness in Emergency Department Patients and Its Effect on Morbidity and Mortality.Journal of intensive care medicine · 2022Article
- Baseline clinical features of COVID-19 patients, delay of hospital admission and clinical outcome: A complex relationship.PloS one · 2022Article
- [Intensive care and Covid].Bulletin de l'Academie nationale de medecine · 2022Review
- Code status documentation at admission in COVID-19 patients: a descriptive cohort study.BMJ open · 2021Article
- Variation in Initial U.S. Hospital Responses to the Coronavirus Disease 2019 Pandemic.Critical care medicine · 2021Observational
- Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
In this analysis we discuss the change in criteria for triage of patients during three different phases of a pandemic like COVID-19, seen from the critical care point of view. Availability of critical care beds has become a hot topic, and in many countries, we have seen a huge increase in the provision of temporary intensive care bed capacity. However, there is a limit where the hospitals may run out of resources to provide critical care, which is heavily dependent on trained staff, just-in-time supply chains for clinical consumables and drugs and advanced equipment. In the first (good) phase, we can still do clinical prioritisation and decision-making as usual, based on the need for intensive care and prognostication: what are the odds for a good result with regard to survival and quality of life. In the next (bad phase), the resources are mostly available, but the system is stressed by many patients arriving over a short time period and auxiliary beds in different places in the hospital being used. We may have to abandon admittance of patients with doubtful prognosis. In the last (ugly) phase, usual medical triage and priority setting may not be sufficient to decrease inflow and there may not be enough intensive care unit beds available. In this phase different criteria must be applied using a utilitarian approach for triage. We argue that this is an important transition where society, and not physicians, must provide guidance to support triage that is no longer based on medical priorities alone.
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