. 2020 Aug 4;173(3):188-194.

doi: 10.7326/M20-1738. Epub 2020 Apr 24.

Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors

Armand H Matheny Antommaria¹, Tyler S Gibb², Amy L McGuire³, Paul Root Wolpe⁴, Matthew K Wynia⁵, Megan K Applewhite⁶, Arthur Caplan⁷, Douglas S Diekema⁸, D Micah Hester⁹, Lisa Soleymani Lehmann¹⁰, Renee McLeod-Sordjan¹¹, Tamar Schiff⁷, Holly K Tabor¹², Sarah E Wieten¹², Jason T Eberl¹³; Task Force of the Association of Bioethics Program Directors

Collaborators, Affiliations

Collaborators

Task Force of the Association of Bioethics Program Directors:
Armand H Matheny Antommaria, Tyler S Gibb, Amy L McGuire, Paul Root Wolpe, Matthew K Wynia, Megan K Applewhite, Arthur Caplan, Douglas S Diekema, D Micah Hester, Lisa Soleymani Lehmann, Renee McLeod-Sordjan, Tamar Schiff, Holly K Tabor, Sarah Wieten, Jason T Eberl

Affiliations

¹ Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, University of Cincinnati School of Medicine, Cincinnati, Ohio (A.H.A.).
² Program in Medical Ethics, Humanities & Law, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan (T.S.G.).
³ Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas (A.L.M.).
⁴ Center for Ethics and School of Medicine, Emory University, Atlanta, Georgia (P.R.W.).
⁵ University of Colorado Center for Bioethics and Humanities, Schools of Medicine and Public Health, and UC Health System, Aurora, Colorado (M.K.W.).
⁶ Alden March Bioethics Institute and Department of Surgery, Albany Medical College, Albany, New York (M.K.A.).
⁷ Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York (A.C., T.S.).
⁸ Departments of Pediatrics and Bioethics & Humanities, University of Washington School of Medicine, Seattle, Washington, Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington (D.S.D.).
⁹ Department of Medical Humanities & Bioethics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas (D.M.H.).
¹⁰ VA New England Healthcare System, Bedford, Massachusetts, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (L.S.L.).
¹¹ Division of Medical Ethics, Department of Medicine, Northwell Health System, New Hyde Park, New York, Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies, Hofstra University, Hempstead, New York (R.M.).
¹² Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California (H.K.T., S.E.W.).
¹³ Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, Missouri (J.T.E.).

PMID: 32330224
PMCID: PMC7207244
DOI: 10.7326/M20-1738

Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors

Armand H Matheny Antommaria et al. Ann Intern Med. 2020.

. 2020 Aug 4;173(3):188-194.

doi: 10.7326/M20-1738. Epub 2020 Apr 24.

Authors

Collaborators

Task Force of the Association of Bioethics Program Directors:
Armand H Matheny Antommaria, Tyler S Gibb, Amy L McGuire, Paul Root Wolpe, Matthew K Wynia, Megan K Applewhite, Arthur Caplan, Douglas S Diekema, D Micah Hester, Lisa Soleymani Lehmann, Renee McLeod-Sordjan, Tamar Schiff, Holly K Tabor, Sarah Wieten, Jason T Eberl

Affiliations

¹ Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, University of Cincinnati School of Medicine, Cincinnati, Ohio (A.H.A.).
² Program in Medical Ethics, Humanities & Law, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan (T.S.G.).
³ Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas (A.L.M.).
⁴ Center for Ethics and School of Medicine, Emory University, Atlanta, Georgia (P.R.W.).
⁵ University of Colorado Center for Bioethics and Humanities, Schools of Medicine and Public Health, and UC Health System, Aurora, Colorado (M.K.W.).
⁶ Alden March Bioethics Institute and Department of Surgery, Albany Medical College, Albany, New York (M.K.A.).
⁷ Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York (A.C., T.S.).
⁸ Departments of Pediatrics and Bioethics & Humanities, University of Washington School of Medicine, Seattle, Washington, Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington (D.S.D.).
⁹ Department of Medical Humanities & Bioethics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas (D.M.H.).
¹⁰ VA New England Healthcare System, Bedford, Massachusetts, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (L.S.L.).
¹¹ Division of Medical Ethics, Department of Medicine, Northwell Health System, New Hyde Park, New York, Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies, Hofstra University, Hempstead, New York (R.M.).
¹² Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California (H.K.T., S.E.W.).
¹³ Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, Missouri (J.T.E.).

PMID: 32330224
PMCID: PMC7207244
DOI: 10.7326/M20-1738

Abstract

Background: The coronavirus disease 2019 pandemic has or threatens to overwhelm health care systems. Many institutions are developing ventilator triage policies.

Objective: To characterize the development of ventilator triage policies and compare policy content.

Design: Survey and mixed-methods content analysis.

Setting: North American hospitals associated with members of the Association of Bioethics Program Directors.

Participants: Program directors.

Measurements: Characteristics of institutions and policies, including triage criteria and triage committee membership.

Results: Sixty-seven program directors responded (response rate, 91.8%); 36 (53.7%) hospitals did not yet have a policy, and 7 (10.4%) hospitals' policies could not be shared. The 29 institutions providing policies were relatively evenly distributed among the 4 U.S. geographic regions (range, 5 to 9 policies per region). Among the 26 unique policies analyzed, 3 (11.3%) were produced by state health departments. The most frequently cited triage criteria were benefit (25 policies [96.2%]), need (14 [53.8%]), age (13 [50.0%]), conservation of resources (10 [38.5%]), and lottery (9 [34.6%]). Twenty-one (80.8%) policies use scoring systems, and 20 of these (95.2%) use a version of the Sequential Organ Failure Assessment score. Among the policies that specify the triage team's composition (23 [88.5%]), all require or recommend a physician member, 20 (87.0%) a nurse, 16 (69.6%) an ethicist, 8 (34.8%) a chaplain, and 8 (34.8%) a respiratory therapist. Thirteen (50.0% of all policies) require or recommend that those making triage decisions not be involved in direct patient care, but only 2 (7.7%) require that their decisions be blinded to ethically irrelevant considerations.

Limitation: The results may not be generalizable to institutions without academic bioethics programs.

Conclusion: Over one half of respondents did not have ventilator triage policies. Policies have substantial heterogeneity, and many omit guidance on fair implementation.

Primary funding source: None.

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Figures

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References

1. Rosen R. I'm a doctor on the front lines of coronavirus. We've thrown out the rule book. Forward. 3 April 2020. Accessed at https://forward.com/opinion/443033/im-a-doctor-on-the-front-lines-of-tre.... on 8 April 2020.
1. McCoy K, Wagner D. Which coronavirus patients will get life-saving ventilators? Guidelines show how hospitals in NYC, US will decide. USA Today. 4 April 2020. Accessed at www.usatoday.com/story/news/2020/04/04/coronavirus-ventilator-shortages-.... on 8 April 2020.
1. Parshley L. You can't use ventilators without sedatives. Now the US is running out of those, too. Vox. 6 April 2020. Accessed at www.vox.com/2020/4/6/21209589/coronavirus-medicine-ventilators-drug-shor.... on 8 April 2020.
1. Hick JL, Barbera JA, Kelen GD. Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009;3:S59-67. [PMID: 19349869] doi:10.1097/DMP.0b013e31819f1ae2. - PubMed
1. Institute of Medicine. Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report. National Academies Pr; 2009. [PMID: 25032361] doi:10.17226/12749. - PubMed

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Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors

Collaborators

Affiliations

Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors

Authors

Collaborators

Affiliations

Abstract

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical