ABSTRACT
Background: This study shows how multiple ethical criteria evaluations result in patient screening and ranking. Furthermore, as Omicron outbreaks increase, hospital emergency departments will become overburdened with critically ill patients. It is a one-of-a-kind global triage algorithm for infectious decreases of COVID-19 and Omicron. The algorithm is qualitative and quantitative, and adaptable to various bio-ethical and social factors. The measurement of the evaluation process eliminates any inconsistencies, which is an advantage of a decision-making algorithm. The proposed algorithm is unique because there are no similar algorithms in the literature that provide triage guidelines based on social ethics, bioethics, and human dignity. Objective: It's simple to evaluate a patient's potential benefits when ethical triage judgments are structured and transparent. Furthermore, decisions made primarily based on economic considerations in stressful situations overlook the socioeconomic realities of the underprivileged. This triage algorithm eliminates the need for ad hoc triage evaluations and facilitates criteria for inclusion, such as human dignity. It also takes into account patient comorbidities and social, ethical issues. Method: Healthcare professionals use predefined ethical criteria to assign relative rankings among patients based on treatment response and social circumstances. It is a Delphi method for evaluating patient illnesses with the help of medical professionals. For example, the admission to the intensive care unit and providing a ventilator depend entirely on hierarchical multidimensional triage scoring results. This algorithm can evaluate triage scores quickly. It is robust, accurate, and quick in assessment, evaluation, and reevaluation during an emergency. A team of three experts can implement this algorithm. Result: The Consistency Scores (CR) show how well clinical and non-clinical ethical criteria may be used to make triage judgments. As a result, all specialists have reported allogeneic reactions in the triage assessment. Furthermore, this system enables decision-makers to identify cognitive biases that may influence their decisions. A Group Consciousness Ratio (GCR) of over 85% indicates that the decision-making process is transparent. Patients with a high level of social dependency, a reasonable probability of recovery, a favorable weighted average comorbidity score, and those who are less fortunate are all considered in the overall triage decision. Conclusions: This algorithm differentiates patients who need ICU (Incentive Care Unit) care and do not immediately require critical resources. As a result, patients queue up on a waiting list when the ICU demand spikes due to the increased incidence of COVID-19 infection or its variants. This situation presents a dilemma for the triage policy. Therefore, a national emergency policy requires monetary and technical assistance to expand healthcare facilities. However, the clarity of this triage policymaking is at odds with decision-makers interested in manipulating results. It is challenging to deal with consistency issues in the Delphi process in group decision-making without professional moderators and valid evaluation metrics. Therefore, transparency, consistency, and strong judgment are essential elements of the presented algorithm. © 2022 by the authors. Licensee ESJ, Italy.
ABSTRACT
I was a member of the Massachusetts advisory working group that wrote the Commonwealth's crisis standards of care guidance for the Covid-19 pandemic, and I was proud of the work we did, thinking carefully about whether age should matter and whether priority should be given to essential workers if there was a scarcity of medical resources, about whether protocols should address issues of structural racism, and so forth. But as a critical care physician, I have concluded that, no matter how sophisticated the ethical analysis, the fundamental approach we proposed was flawed and virtually impossible to implement. All the existing allocation protocols that states developed are based on the assumption that clinicians will be faced with the task of selecting which patients will be offered a ventilator from among a population of patients who are each in need of one. The protocols then assign patients a priority category, and the protocols specify "tie-breaking" criteria to be used when necessary. The problem with this approach for ventilator allocation is that it has no relationship whatsoever to what happens in the real world.