Intensive medicine priority decisions during the COVID-19 pandemic (INTENSIVE TRIAGE)

Decisions on whether patients should be offered intensive care treatment are made daily by intensive care physicians. When in doubt, a common strategy is to offer hospitalization in an intensive unit and perform time limited treatment trials. During the stay on an intensive care unit the benefits of the treatment will be reassessed regularly by a multidisciplinary team. Most deaths in intensive care units worldwide occur after a decision to withdraw treatment. In a crisis situation such as a pandemic, changes must be expected in relation to which considerations are given weight in priority decisions / «triage to intensive care». It is to be expected that more patients will be rejected than during periods of normal operation. 

In spite of the increase in capacity in response to a crisis, it is to be expected that the relationship between need and capacity may be threatened. We are currently in Norway in a COVID-19 situation without anyone quite knowing how the situation will develop and what the consequences may be. 

The aim of the study is to increase knowledge about physicians' ethical reasoning, specifically the causes and considerations underlying decisions to refrain from intensive care, both among patients with and without COVID-19 infection. We also want to elucidate how the number of refusals, causes and considerations may change at different stages of the COVID-19 epidemic in Norway, as well as how this affects resources, numbers of intensive beds and mortality. 

The study will be conducted as a prospective multicenter observational study. Decisions on refusals are continuously recorded. Main data are the physicians' reasoning, that are recorded when completing the study form with pre-defined categories of causes and considerations with the possibility of short free text. The form is filled in continuously. The burden on the hospitalsis described by pandemic phase (steps 1 - 5 according to FHI), hospital emergency preparedness level (normal, green, yellow, red), national COVID-19 data with number of ill patients, hospitalized deaths, number of intensive beds in use at various stages in participating hospitals, before / after triage criteria.

Project leader:

Kjetil Sunde

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