CovidStanfordV1, Main, Exploration, bibRecord, 000159

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

Identifieur interne : 000159 ( Main/Exploration ); précédent : 000158; suivant : 000160

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

Auteurs : 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 E. Wieten ; Jason T. Eberl

Source :

Annals of internal medicine [ 1539-3704 ] ; 2020.

RBID : pubmed:32330224

Descripteurs français

KwdFr :
- Betacoronavirus (MeSH), Bioéthique (MeSH), Enquêtes et questionnaires (MeSH), Humains (MeSH), Hôpitaux (MeSH), Infections à coronavirus (thérapie), Pandémies (MeSH), Pneumopathie virale (thérapie), Politique de santé (MeSH), Respirateurs artificiels (ressources et distribution), Triage (normes), Triage (éthique), Ventilation artificielle (normes), Ventilation artificielle (éthique), États-Unis (MeSH).
MESH :
- normes : Triage, Ventilation artificielle.
- ressources et distribution : Respirateurs artificiels.
- thérapie : Infections à coronavirus, Pneumopathie virale.
- éthique : Triage, Ventilation artificielle.
- Betacoronavirus, Bioéthique, Enquêtes et questionnaires, Humains, Hôpitaux, Pandémies, Politique de santé, États-Unis.
Wicri :
- geographic : États-Unis.

English descriptors

KwdEn :
- Betacoronavirus (MeSH), Bioethics (MeSH), COVID-19 (MeSH), Coronavirus Infections (therapy), Health Policy (MeSH), Hospitals (MeSH), Humans (MeSH), Pandemics (MeSH), Pneumonia, Viral (therapy), Respiration, Artificial (ethics), Respiration, Artificial (standards), SARS-CoV-2 (MeSH), Surveys and Questionnaires (MeSH), Triage (ethics), Triage (standards), United States (MeSH), Ventilators, Mechanical (supply & distribution).
MESH :
- geographic : United States.
- ethics : Respiration, Artificial, Triage.
- standards : Respiration, Artificial, Triage.
- supply & distribution : Ventilators, Mechanical.
- therapy : Coronavirus Infections, Pneumonia, Viral.
- Betacoronavirus, Bioethics, COVID-19, Health Policy, Hospitals, Humans, Pandemics, SARS-CoV-2, Surveys and Questionnaires.

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.

DOI: 10.7326/M20-1738
PubMed: 32330224
PubMed Central: PMC7207244

Affiliations:

Links toward previous steps (curation, corpus...)

to stream Main, to step Corpus: 000791
to stream Main, to step Curation: 000791

Le document en format XML

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<author><name sortKey="Antommaria, Armand H Matheny" sort="Antommaria, Armand H Matheny" uniqKey="Antommaria A" first="Armand H Matheny" last="Antommaria">Armand H Matheny Antommaria</name>
<affiliation><nlm:affiliation>Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, University of Cincinnati School of Medicine, Cincinnati, Ohio (A.H.A.).</nlm:affiliation>
<wicri:noCountry code="subField">Ohio (A.H.A.).</wicri:noCountry>
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<author><name sortKey="Gibb, Tyler S" sort="Gibb, Tyler S" uniqKey="Gibb T" first="Tyler S" last="Gibb">Tyler S. Gibb</name>
<affiliation><nlm:affiliation>Program in Medical Ethics, Humanities & Law, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan (T.S.G.).</nlm:affiliation>
<wicri:noCountry code="subField">Michigan (T.S.G.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Mcguire, Amy L" sort="Mcguire, Amy L" uniqKey="Mcguire A" first="Amy L" last="Mcguire">Amy L. Mcguire</name>
<affiliation><nlm:affiliation>Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas (A.L.M.).</nlm:affiliation>
<wicri:noCountry code="subField">Texas (A.L.M.).</wicri:noCountry>
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<author><name sortKey="Wolpe, Paul Root" sort="Wolpe, Paul Root" uniqKey="Wolpe P" first="Paul Root" last="Wolpe">Paul Root Wolpe</name>
<affiliation><nlm:affiliation>Center for Ethics and School of Medicine, Emory University, Atlanta, Georgia (P.R.W.).</nlm:affiliation>
<wicri:noCountry code="subField">Georgia (P.R.W.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Wynia, Matthew K" sort="Wynia, Matthew K" uniqKey="Wynia M" first="Matthew K" last="Wynia">Matthew K. Wynia</name>
<affiliation><nlm:affiliation>University of Colorado Center for Bioethics and Humanities, Schools of Medicine and Public Health, and UC Health System, Aurora, Colorado (M.K.W.).</nlm:affiliation>
<wicri:noCountry code="subField">Colorado (M.K.W.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Applewhite, Megan K" sort="Applewhite, Megan K" uniqKey="Applewhite M" first="Megan K" last="Applewhite">Megan K. Applewhite</name>
<affiliation><nlm:affiliation>Alden March Bioethics Institute and Department of Surgery, Albany Medical College, Albany, New York (M.K.A.).</nlm:affiliation>
<wicri:noCountry code="subField">New York (M.K.A.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Caplan, Arthur" sort="Caplan, Arthur" uniqKey="Caplan A" first="Arthur" last="Caplan">Arthur Caplan</name>
<affiliation><nlm:affiliation>Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York (A.C., T.S.).</nlm:affiliation>
<wicri:noCountry code="subField">T.S.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Diekema, Douglas S" sort="Diekema, Douglas S" uniqKey="Diekema D" first="Douglas S" last="Diekema">Douglas S. Diekema</name>
<affiliation><nlm:affiliation>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.).</nlm:affiliation>
<wicri:noCountry code="subField">Washington (D.S.D.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Hester, D Micah" sort="Hester, D Micah" uniqKey="Hester D" first="D Micah" last="Hester">D Micah Hester</name>
<affiliation><nlm:affiliation>Department of Medical Humanities & Bioethics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas (D.M.H.).</nlm:affiliation>
<wicri:noCountry code="subField">Arkansas (D.M.H.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Lehmann, Lisa Soleymani" sort="Lehmann, Lisa Soleymani" uniqKey="Lehmann L" first="Lisa Soleymani" last="Lehmann">Lisa Soleymani Lehmann</name>
<affiliation><nlm:affiliation>VA New England Healthcare System, Bedford, Massachusetts, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (L.S.L.).</nlm:affiliation>
<wicri:noCountry code="subField">Massachusetts (L.S.L.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Mcleod Sordjan, Renee" sort="Mcleod Sordjan, Renee" uniqKey="Mcleod Sordjan R" first="Renee" last="Mcleod-Sordjan">Renee Mcleod-Sordjan</name>
<affiliation><nlm:affiliation>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.).</nlm:affiliation>
<wicri:noCountry code="subField">New York (R.M.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Schiff, Tamar" sort="Schiff, Tamar" uniqKey="Schiff T" first="Tamar" last="Schiff">Tamar Schiff</name>
<affiliation><nlm:affiliation>Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York (A.C., T.S.).</nlm:affiliation>
<wicri:noCountry code="subField">T.S.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Tabor, Holly K" sort="Tabor, Holly K" uniqKey="Tabor H" first="Holly K" last="Tabor">Holly K. Tabor</name>
<affiliation><nlm:affiliation>Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California (H.K.T., S.E.W.).</nlm:affiliation>
<wicri:noCountry code="subField">S.E.W.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Wieten, Sarah E" sort="Wieten, Sarah E" uniqKey="Wieten S" first="Sarah E" last="Wieten">Sarah E. Wieten</name>
<affiliation><nlm:affiliation>Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California (H.K.T., S.E.W.).</nlm:affiliation>
<wicri:noCountry code="subField">S.E.W.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Eberl, Jason T" sort="Eberl, Jason T" uniqKey="Eberl J" first="Jason T" last="Eberl">Jason T. Eberl</name>
<affiliation><nlm:affiliation>Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, Missouri (J.T.E.).</nlm:affiliation>
<wicri:noCountry code="subField">Missouri (J.T.E.).</wicri:noCountry>
</affiliation>
</author>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors.</title>
<author><name sortKey="Antommaria, Armand H Matheny" sort="Antommaria, Armand H Matheny" uniqKey="Antommaria A" first="Armand H Matheny" last="Antommaria">Armand H Matheny Antommaria</name>
<affiliation><nlm:affiliation>Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, University of Cincinnati School of Medicine, Cincinnati, Ohio (A.H.A.).</nlm:affiliation>
<wicri:noCountry code="subField">Ohio (A.H.A.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Gibb, Tyler S" sort="Gibb, Tyler S" uniqKey="Gibb T" first="Tyler S" last="Gibb">Tyler S. Gibb</name>
<affiliation><nlm:affiliation>Program in Medical Ethics, Humanities & Law, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan (T.S.G.).</nlm:affiliation>
<wicri:noCountry code="subField">Michigan (T.S.G.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Mcguire, Amy L" sort="Mcguire, Amy L" uniqKey="Mcguire A" first="Amy L" last="Mcguire">Amy L. Mcguire</name>
<affiliation><nlm:affiliation>Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas (A.L.M.).</nlm:affiliation>
<wicri:noCountry code="subField">Texas (A.L.M.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Wolpe, Paul Root" sort="Wolpe, Paul Root" uniqKey="Wolpe P" first="Paul Root" last="Wolpe">Paul Root Wolpe</name>
<affiliation><nlm:affiliation>Center for Ethics and School of Medicine, Emory University, Atlanta, Georgia (P.R.W.).</nlm:affiliation>
<wicri:noCountry code="subField">Georgia (P.R.W.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Wynia, Matthew K" sort="Wynia, Matthew K" uniqKey="Wynia M" first="Matthew K" last="Wynia">Matthew K. Wynia</name>
<affiliation><nlm:affiliation>University of Colorado Center for Bioethics and Humanities, Schools of Medicine and Public Health, and UC Health System, Aurora, Colorado (M.K.W.).</nlm:affiliation>
<wicri:noCountry code="subField">Colorado (M.K.W.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Applewhite, Megan K" sort="Applewhite, Megan K" uniqKey="Applewhite M" first="Megan K" last="Applewhite">Megan K. Applewhite</name>
<affiliation><nlm:affiliation>Alden March Bioethics Institute and Department of Surgery, Albany Medical College, Albany, New York (M.K.A.).</nlm:affiliation>
<wicri:noCountry code="subField">New York (M.K.A.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Caplan, Arthur" sort="Caplan, Arthur" uniqKey="Caplan A" first="Arthur" last="Caplan">Arthur Caplan</name>
<affiliation><nlm:affiliation>Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York (A.C., T.S.).</nlm:affiliation>
<wicri:noCountry code="subField">T.S.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Diekema, Douglas S" sort="Diekema, Douglas S" uniqKey="Diekema D" first="Douglas S" last="Diekema">Douglas S. Diekema</name>
<affiliation><nlm:affiliation>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.).</nlm:affiliation>
<wicri:noCountry code="subField">Washington (D.S.D.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Hester, D Micah" sort="Hester, D Micah" uniqKey="Hester D" first="D Micah" last="Hester">D Micah Hester</name>
<affiliation><nlm:affiliation>Department of Medical Humanities & Bioethics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas (D.M.H.).</nlm:affiliation>
<wicri:noCountry code="subField">Arkansas (D.M.H.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Lehmann, Lisa Soleymani" sort="Lehmann, Lisa Soleymani" uniqKey="Lehmann L" first="Lisa Soleymani" last="Lehmann">Lisa Soleymani Lehmann</name>
<affiliation><nlm:affiliation>VA New England Healthcare System, Bedford, Massachusetts, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (L.S.L.).</nlm:affiliation>
<wicri:noCountry code="subField">Massachusetts (L.S.L.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Mcleod Sordjan, Renee" sort="Mcleod Sordjan, Renee" uniqKey="Mcleod Sordjan R" first="Renee" last="Mcleod-Sordjan">Renee Mcleod-Sordjan</name>
<affiliation><nlm:affiliation>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.).</nlm:affiliation>
<wicri:noCountry code="subField">New York (R.M.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Schiff, Tamar" sort="Schiff, Tamar" uniqKey="Schiff T" first="Tamar" last="Schiff">Tamar Schiff</name>
<affiliation><nlm:affiliation>Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York (A.C., T.S.).</nlm:affiliation>
<wicri:noCountry code="subField">T.S.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Tabor, Holly K" sort="Tabor, Holly K" uniqKey="Tabor H" first="Holly K" last="Tabor">Holly K. Tabor</name>
<affiliation><nlm:affiliation>Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California (H.K.T., S.E.W.).</nlm:affiliation>
<wicri:noCountry code="subField">S.E.W.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Wieten, Sarah E" sort="Wieten, Sarah E" uniqKey="Wieten S" first="Sarah E" last="Wieten">Sarah E. Wieten</name>
<affiliation><nlm:affiliation>Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California (H.K.T., S.E.W.).</nlm:affiliation>
<wicri:noCountry code="subField">S.E.W.).</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Eberl, Jason T" sort="Eberl, Jason T" uniqKey="Eberl J" first="Jason T" last="Eberl">Jason T. Eberl</name>
<affiliation><nlm:affiliation>Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, Missouri (J.T.E.).</nlm:affiliation>
<wicri:noCountry code="subField">Missouri (J.T.E.).</wicri:noCountry>
</affiliation>
</author>
</analytic>
<series><title level="j">Annals of internal medicine</title>
<idno type="eISSN">1539-3704</idno>
<imprint><date when="2020" type="published">2020</date>
</imprint>
</series>
</biblStruct>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Betacoronavirus (MeSH)</term>
<term>Bioethics (MeSH)</term>
<term>COVID-19 (MeSH)</term>
<term>Coronavirus Infections (therapy)</term>
<term>Health Policy (MeSH)</term>
<term>Hospitals (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Pandemics (MeSH)</term>
<term>Pneumonia, Viral (therapy)</term>
<term>Respiration, Artificial (ethics)</term>
<term>Respiration, Artificial (standards)</term>
<term>SARS-CoV-2 (MeSH)</term>
<term>Surveys and Questionnaires (MeSH)</term>
<term>Triage (ethics)</term>
<term>Triage (standards)</term>
<term>United States (MeSH)</term>
<term>Ventilators, Mechanical (supply & distribution)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Betacoronavirus (MeSH)</term>
<term>Bioéthique (MeSH)</term>
<term>Enquêtes et questionnaires (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Hôpitaux (MeSH)</term>
<term>Infections à coronavirus (thérapie)</term>
<term>Pandémies (MeSH)</term>
<term>Pneumopathie virale (thérapie)</term>
<term>Politique de santé (MeSH)</term>
<term>Respirateurs artificiels (ressources et distribution)</term>
<term>Triage (normes)</term>
<term>Triage (éthique)</term>
<term>Ventilation artificielle (normes)</term>
<term>Ventilation artificielle (éthique)</term>
<term>États-Unis (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="geographic" xml:lang="en"><term>United States</term>
</keywords>
<keywords scheme="MESH" qualifier="ethics" xml:lang="en"><term>Respiration, Artificial</term>
<term>Triage</term>
</keywords>
<keywords scheme="MESH" qualifier="normes" xml:lang="fr"><term>Triage</term>
<term>Ventilation artificielle</term>
</keywords>
<keywords scheme="MESH" qualifier="ressources et distribution" xml:lang="fr"><term>Respirateurs artificiels</term>
</keywords>
<keywords scheme="MESH" qualifier="standards" xml:lang="en"><term>Respiration, Artificial</term>
<term>Triage</term>
</keywords>
<keywords scheme="MESH" qualifier="supply & distribution" xml:lang="en"><term>Ventilators, Mechanical</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Infections à coronavirus</term>
<term>Pneumopathie virale</term>
</keywords>
<keywords scheme="MESH" qualifier="éthique" xml:lang="fr"><term>Triage</term>
<term>Ventilation artificielle</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Betacoronavirus</term>
<term>Bioethics</term>
<term>COVID-19</term>
<term>Health Policy</term>
<term>Hospitals</term>
<term>Humans</term>
<term>Pandemics</term>
<term>SARS-CoV-2</term>
<term>Surveys and Questionnaires</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Betacoronavirus</term>
<term>Bioéthique</term>
<term>Enquêtes et questionnaires</term>
<term>Humains</term>
<term>Hôpitaux</term>
<term>Pandémies</term>
<term>Politique de santé</term>
<term>États-Unis</term>
</keywords>
<keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>États-Unis</term>
</keywords>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>The coronavirus disease 2019 pandemic has or threatens to overwhelm health care systems. Many institutions are developing ventilator triage policies.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b>
</p>
<p>To characterize the development of ventilator triage policies and compare policy content.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>DESIGN</b>
</p>
<p>Survey and mixed-methods content analysis.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>SETTING</b>
</p>
<p>North American hospitals associated with members of the Association of Bioethics Program Directors.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>PARTICIPANTS</b>
</p>
<p>Program directors.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>MEASUREMENTS</b>
</p>
<p>Characteristics of institutions and policies, including triage criteria and triage committee membership.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>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.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>LIMITATION</b>
</p>
<p>The results may not be generalizable to institutions without academic bioethics programs.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSION</b>
</p>
<p>Over one half of respondents did not have ventilator triage policies. Policies have substantial heterogeneity, and many omit guidance on fair implementation.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>PRIMARY FUNDING SOURCE</b>
</p>
<p>None.</p>
</div>
</front>
</TEI>
<pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32330224</PMID>
<DateCompleted><Year>2020</Year>
<Month>08</Month>
<Day>12</Day>
</DateCompleted>
<DateRevised><Year>2020</Year>
<Month>12</Month>
<Day>18</Day>
</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1539-3704</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>173</Volume>
<Issue>3</Issue>
<PubDate><Year>2020</Year>
<Month>08</Month>
<Day>04</Day>
</PubDate>
</JournalIssue>
<Title>Annals of internal medicine</Title>
<ISOAbbreviation>Ann Intern Med</ISOAbbreviation>
</Journal>
<ArticleTitle>Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors.</ArticleTitle>
<Pagination><MedlinePgn>188-194</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.7326/M20-1738</ELocationID>
<Abstract><AbstractText Label="BACKGROUND">The coronavirus disease 2019 pandemic has or threatens to overwhelm health care systems. Many institutions are developing ventilator triage policies.</AbstractText>
<AbstractText Label="OBJECTIVE">To characterize the development of ventilator triage policies and compare policy content.</AbstractText>
<AbstractText Label="DESIGN">Survey and mixed-methods content analysis.</AbstractText>
<AbstractText Label="SETTING">North American hospitals associated with members of the Association of Bioethics Program Directors.</AbstractText>
<AbstractText Label="PARTICIPANTS">Program directors.</AbstractText>
<AbstractText Label="MEASUREMENTS">Characteristics of institutions and policies, including triage criteria and triage committee membership.</AbstractText>
<AbstractText Label="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.</AbstractText>
<AbstractText Label="LIMITATION">The results may not be generalizable to institutions without academic bioethics programs.</AbstractText>
<AbstractText Label="CONCLUSION">Over one half of respondents did not have ventilator triage policies. Policies have substantial heterogeneity, and many omit guidance on fair implementation.</AbstractText>
<AbstractText Label="PRIMARY FUNDING SOURCE">None.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Antommaria</LastName>
<ForeName>Armand H Matheny</ForeName>
<Initials>AHM</Initials>
<AffiliationInfo><Affiliation>Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, University of Cincinnati School of Medicine, Cincinnati, Ohio (A.H.A.).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Gibb</LastName>
<ForeName>Tyler S</ForeName>
<Initials>TS</Initials>
<AffiliationInfo><Affiliation>Program in Medical Ethics, Humanities & Law, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan (T.S.G.).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>McGuire</LastName>
<ForeName>Amy L</ForeName>
<Initials>AL</Initials>
<AffiliationInfo><Affiliation>Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas (A.L.M.).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Wolpe</LastName>
<ForeName>Paul Root</ForeName>
<Initials>PR</Initials>
<AffiliationInfo><Affiliation>Center for Ethics and School of Medicine, Emory University, Atlanta, Georgia (P.R.W.).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Wynia</LastName>
<ForeName>Matthew K</ForeName>
<Initials>MK</Initials>
<AffiliationInfo><Affiliation>University of Colorado Center for Bioethics and Humanities, Schools of Medicine and Public Health, and UC Health System, Aurora, Colorado (M.K.W.).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Applewhite</LastName>
<ForeName>Megan K</ForeName>
<Initials>MK</Initials>
<AffiliationInfo><Affiliation>Alden March Bioethics Institute and Department of Surgery, Albany Medical College, Albany, New York (M.K.A.).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Caplan</LastName>
<ForeName>Arthur</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York (A.C., T.S.).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Diekema</LastName>
<ForeName>Douglas S</ForeName>
<Initials>DS</Initials>
<AffiliationInfo><Affiliation>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.).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Hester</LastName>
<ForeName>D Micah</ForeName>
<Initials>DM</Initials>
<AffiliationInfo><Affiliation>Department of Medical Humanities & Bioethics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas (D.M.H.).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Lehmann</LastName>
<ForeName>Lisa Soleymani</ForeName>
<Initials>LS</Initials>
<AffiliationInfo><Affiliation>VA New England Healthcare System, Bedford, Massachusetts, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (L.S.L.).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>McLeod-Sordjan</LastName>
<ForeName>Renee</ForeName>
<Initials>R</Initials>
<AffiliationInfo><Affiliation>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.).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Schiff</LastName>
<ForeName>Tamar</ForeName>
<Initials>T</Initials>
<AffiliationInfo><Affiliation>Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York (A.C., T.S.).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Tabor</LastName>
<ForeName>Holly K</ForeName>
<Initials>HK</Initials>
<AffiliationInfo><Affiliation>Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California (H.K.T., S.E.W.).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Wieten</LastName>
<ForeName>Sarah E</ForeName>
<Initials>SE</Initials>
<AffiliationInfo><Affiliation>Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California (H.K.T., S.E.W.).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Eberl</LastName>
<ForeName>Jason T</ForeName>
<Initials>JT</Initials>
<AffiliationInfo><Affiliation>Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, Missouri (J.T.E.).</Affiliation>
</AffiliationInfo>
</Author>
</AuthorList>
<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic"><Year>2020</Year>
<Month>04</Month>
<Day>24</Day>
</ArticleDate>
</Article>
<MedlineJournalInfo><Country>United States</Country>
<MedlineTA>Ann Intern Med</MedlineTA>
<NlmUniqueID>0372351</NlmUniqueID>
<ISSNLinking>0003-4819</ISSNLinking>
</MedlineJournalInfo>
<CitationSubset>AIM</CitationSubset>
<CitationSubset>IM</CitationSubset>
<MeshHeadingList><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="N">Betacoronavirus</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D001675" MajorTopicYN="N">Bioethics</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName>
<QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D006291" MajorTopicYN="N">Health Policy</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D006761" MajorTopicYN="N">Hospitals</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName>
<QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D012121" MajorTopicYN="N">Respiration, Artificial</DescriptorName>
<QualifierName UI="Q000941" MajorTopicYN="Y">ethics</QualifierName>
<QualifierName UI="Q000592" MajorTopicYN="Y">standards</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000086402" MajorTopicYN="N">SARS-CoV-2</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D011795" MajorTopicYN="N">Surveys and Questionnaires</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D014218" MajorTopicYN="N">Triage</DescriptorName>
<QualifierName UI="Q000941" MajorTopicYN="Y">ethics</QualifierName>
<QualifierName UI="Q000592" MajorTopicYN="Y">standards</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D014481" MajorTopicYN="N" Type="Geographic">United States</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D012122" MajorTopicYN="N">Ventilators, Mechanical</DescriptorName>
<QualifierName UI="Q000600" MajorTopicYN="N">supply & distribution</QualifierName>
</MeshHeading>
</MeshHeadingList>
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<affiliations><list></list>
<tree><noCountry><name sortKey="Antommaria, Armand H Matheny" sort="Antommaria, Armand H Matheny" uniqKey="Antommaria A" first="Armand H Matheny" last="Antommaria">Armand H Matheny Antommaria</name>
<name sortKey="Applewhite, Megan K" sort="Applewhite, Megan K" uniqKey="Applewhite M" first="Megan K" last="Applewhite">Megan K. Applewhite</name>
<name sortKey="Caplan, Arthur" sort="Caplan, Arthur" uniqKey="Caplan A" first="Arthur" last="Caplan">Arthur Caplan</name>
<name sortKey="Diekema, Douglas S" sort="Diekema, Douglas S" uniqKey="Diekema D" first="Douglas S" last="Diekema">Douglas S. Diekema</name>
<name sortKey="Eberl, Jason T" sort="Eberl, Jason T" uniqKey="Eberl J" first="Jason T" last="Eberl">Jason T. Eberl</name>
<name sortKey="Gibb, Tyler S" sort="Gibb, Tyler S" uniqKey="Gibb T" first="Tyler S" last="Gibb">Tyler S. Gibb</name>
<name sortKey="Hester, D Micah" sort="Hester, D Micah" uniqKey="Hester D" first="D Micah" last="Hester">D Micah Hester</name>
<name sortKey="Lehmann, Lisa Soleymani" sort="Lehmann, Lisa Soleymani" uniqKey="Lehmann L" first="Lisa Soleymani" last="Lehmann">Lisa Soleymani Lehmann</name>
<name sortKey="Mcguire, Amy L" sort="Mcguire, Amy L" uniqKey="Mcguire A" first="Amy L" last="Mcguire">Amy L. Mcguire</name>
<name sortKey="Mcleod Sordjan, Renee" sort="Mcleod Sordjan, Renee" uniqKey="Mcleod Sordjan R" first="Renee" last="Mcleod-Sordjan">Renee Mcleod-Sordjan</name>
<name sortKey="Schiff, Tamar" sort="Schiff, Tamar" uniqKey="Schiff T" first="Tamar" last="Schiff">Tamar Schiff</name>
<name sortKey="Tabor, Holly K" sort="Tabor, Holly K" uniqKey="Tabor H" first="Holly K" last="Tabor">Holly K. Tabor</name>
<name sortKey="Wieten, Sarah E" sort="Wieten, Sarah E" uniqKey="Wieten S" first="Sarah E" last="Wieten">Sarah E. Wieten</name>
<name sortKey="Wolpe, Paul Root" sort="Wolpe, Paul Root" uniqKey="Wolpe P" first="Paul Root" last="Wolpe">Paul Root Wolpe</name>
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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.

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

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