CHEST Releases Implementation Guide for Triage of Scarce Critical Care Resources in COVID-19
April 16, 2020
Glenview, IL — While the health-care community moves quickly to respond to the increasing demand for critical patient care for those affected by the COVID-19 pandemic, the American College of Chest Physicians (CHEST) partnered with the Task Force for Mass Critical Care to release Triage of Scarce Critical Care Resources in COVID-19: An Implementation Guide for Regional Allocation: An Expert Panel Report of the Task Force for Mass Critical Care and the American College of Chest Physicians.
The expert report guides how triage must be implemented while maintaining the underlying ethical principles of social justice, beneficence, nonmaleficence, respect for persons and their dignity, veracity and the need to uphold trust within society, and fidelity to one another within health systems. The authors state the use of a triage plan that limits the delivery of critical care should be rare, but the potential consequences of failing to prepare for this eventuality are serious.
“COVID-19 is a global concern that is having a significant impact on the way we live and how health care providers can treat the overwhelming number of critical patients we are experiencing. We have faced disasters and pandemics, most notably the 2009 influenza A(H1N1) pandemic and the Ebola outbreak in West Africa, but nothing has forced the U.S. to look at how we triage resources and patients when we have exhausted our ability to expand critical care to surge capacity, like we are facing today,” says Stephanie M. Levine, MD, FCCP, and President of CHEST.
The report was developed by CHEST with the Task Force for Mass Critical Care, which represents a broad scope of clinical fields from the U.S. and abroad and is endorsed by the Society of Critical Care Medicine and American Association of Critical-Care Nurses. Its basis is the 2014 document Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement.
“The overriding message in this document is that triage plans are necessary to ensure the greatest benefit to the greatest number. We need to coordinate our efforts and to expand capacity in order to maintain the function of the health care system and prevent random or otherwise inequitable distribution of scarce resources if we are to save more lives,” said Michael Christian, MD, member of the task force and CHEST.
The new statement emphasizes that triage of scarce resources must strive to be a process that is ethical and fair to all focused first on expanding capacity across hospital systems. The surge capacity planning efforts of the facility must be integrated with other hospitals in the area to ensure information sharing, consistent policies, and patient and resource movement to diffuse impact and to ensure a consistent standard of care in the region. Actual clinical criteria should be approved by a clinical care committee and updated as additional information about the specific epidemiologic and outcome characteristics of the disease are understood.
This statement also addresses the needs of critical care staff stating that training on the use of triage and companion decision support tools to ensure consistent implementation is essential. Triage decisions must be made collaboratively, using a team-based approach that includes a designated triage officer, the direct care providers, and support from hospital ethics and palliative care experts when necessary.
Read more: https://journal.chestnet.org/article/S0012-3692(20)30691-7/fulltext.
CHEST will continue to release additional resources in response to the COVID-19 pandemic to support physicians and patients. For additional resources, go to: chestnet.org
About the American College of Chest Physicians®
CHEST is the global leader in prevention, diagnosis, and treatment of chest diseases. Its mission is to champion advanced clinical practice, education communication, and research in chest medicine. It serves as an essential connection to clinical knowledge and resources for its 19,000+ members from around the world who provide patient care in pulmonary, critical care, and sleep medicine. For information about the American College of Chest Physicians, and its flagship journal CHEST®, visit chestnet.org.