Physician and administrator experience of preparing to implement Ontario's intensive care unit Triage Emergency Standard of Care during the COVID-19 pandemic: a qualitative study.

CMAJ open Pub Date : 2023-09-19 Print Date: 2023-09-01 DOI:10.9778/cmajo.20220168
Brandon A Heidinger, Ariane Downar, Andrea Frolic, James Downar, Sarina R Isenberg
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引用次数: 0

Abstract

Background: As the COVID-19 pandemic created a surge in demand for critical care resources, the province of Ontario, Canada, released the Adult Critical Care Clinical Emergency Standard of Care for Major Surge (Emergency Standard of Care [ESoC]), a triage framework to guide the allocation of critical care resources in the expectation that intensive care units would be overwhelmed. Our aim was to understand physicians' and administrators' experiences and perceptions of planning to implement the ESoC, and to identify ways to improve critical care triage processes for future pandemics.

Methods: We conducted semistructured qualitative interviews with critical care, emergency and internal medicine physicians, and hospital administrators from various Ontario health regions who were involved in their hospital's or region's ESoC implementation planning. Interviews were conducted virtually between April and October 2021. We analyzed the data using thematic analysis.

Results: We conducted interviews with 11 physicians and 10 hospital administrators representing 9 health regions. We identified 4 themes regarding participants' preparation to implement the ESoC: infrastructure to enable effective triage implementation; social, medical and political supports to enable effective triage implementation; moral dimensions of triage implementation; and communication of triage results. Participants outlined administrative and implementation-related improvements that could be provided at the provincial level, such as billing codes for ESoC. They also suggested improving ethical supports for the usability and quality of the ESoC (e.g., designating an ethicist in each region), and ways to improve the efficiency and usability of the tools for assessing short-term mortality risk (e.g., create information technology solutions such as a dashboard).

Interpretation: The implementation of a jurisdiction-level triage framework poses moral challenges for a health care system, but it also requires dedicated infrastructure, as well as institutional supports. Lessons learned from Ontario's process to prepare for ESoC implementation, as well as participants' suggestions, can be used for planning for current and future pandemics.

新冠肺炎大流行期间准备实施安大略省重症监护室分流紧急护理标准的医生和管理人员经验:一项定性研究。
背景:随着新冠肺炎大流行导致对重症监护资源的需求激增,加拿大安大略省发布了《成人重症监护临床紧急护理标准》(紧急护理标准〔ESoC〕),这是一个分诊框架,用于指导重症监护资源分配,预计重症监护室将不堪重负。我们的目的是了解医生和管理人员在计划实施ESoC方面的经验和看法,并确定改进未来流行病重症监护分诊流程的方法。方法:我们对安大略省不同卫生地区的重症监护、急诊和内科医生以及参与其医院或地区ESoC实施规划的医院管理人员进行了半结构定性访谈。访谈实际上是在2021年4月至10月之间进行的。我们使用专题分析法对数据进行了分析。结果:我们采访了来自9个健康地区的11名医生和10名医院管理人员。我们确定了关于参与者准备实施ESoC的4个主题:实现有效分诊实施的基础设施;提供社会、医疗和政治支持,以便有效实施分流;分诊实施的道德层面;以及分诊结果的交流。与会者概述了可以在省级提供的行政和实施方面的改进,例如ESoC的计费代码。他们还建议改善对ESoC可用性和质量的伦理支持(例如,在每个地区指定一名伦理学家),以及如何提高评估短期死亡风险工具的效率和可用性(例如,创建仪表板等信息技术解决方案)。解释:司法管辖区级别的分诊框架的实施对医疗保健系统构成了道德挑战,但也需要专门的基础设施和机构支持。从安大略省实施ESoC的准备过程中吸取的经验教训,以及参与者的建议,可用于规划当前和未来的流行病。
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CiteScore
5.40
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