Patient Admission and Mechanical Ventilator Allocation Decision-Making Processes by Frontline Medical Professionals in a Japanese ICU During the Covid-19 Pandemic

A Qualitative Study

Datos Bibliográficos

ID4645340
AutoresSakura Ishizaki (0000-0002-4852-3789, Grinnell College, autor de correspondencia), Kazuaki Jindai (0000-0003-4679-3862, Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan), Hiroki Saito (0000-0003-3234-103X, St. Marianna University School of Medicine), Hitoshi Oshitani (0000-0001-7256-9333, Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan), Tess Kulstad González (Grinnell College)
Año2023
Volumen33
Número14
Páginas1291-1304
Fecha de publicación2023-12-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaQualitative Health Research (JOURNAL)
Identificadores de la revistaISSN: 1049-7323 • E-ISSN: 1552-7557
EditorialSAGE Publications Inc (PUBLISHER)
DOI10.1177/10497323231201026
PMID37846588
OpenAlexW4387692818
IdiomaEN
Referencias citadas30

During the COVID-19 pandemic, the need to triage COVID-19 patients in ICUs emerged globally. Triage guidelines were established in many countries; however, the actual triage decision-making processes and decisions themselves made by frontline medical providers may not have exactly reflected those guidelines. Despite the need to understand decisions and processes in practice regarding patient ICU admission and mechanical ventilator usage to identify areas of improvement for medical care provision, such research is limited. This qualitative study was conducted to identify the decision-making processes regarding COVID-19 patient ICU admissions and mechanical ventilator allocation by frontline medical providers and issues associated with those processes in an ICU during the COVID-19 pandemic. Semi-structured, in-depth interviews were conducted with ICU physicians and nurses working at an urban tertiary referral hospital in Japan between February and April 2022. Patient characteristics that influenced triage decisions made by physicians and the interaction between physicians, nurses, and senior management staff upon making such decisions are discussed in this article. An implicated issue was the lack of legal support for Japanese physicians to practice withdrawal of life-sustaining treatments even during emergencies. Another issue was the impact of non-clinical forces-likely specific to health emergencies-on physicians' decisions regarding mechanical ventilator allocation, where such forces imposed a significant mental burden on the medical providers. We consider public policy and legal implications for future pandemics

Disease · Intensive care · Intensive care medicine · Medical emergency · Pandemic · Qualitative research · Referral · Retrospective cohort study · Tertiary referral hospital · Triage · COVID-19 and healthcare impacts · Disaster Response and Management · Family and Patient Care in Intensive Care Units · Medicine · Nursing