Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong.
Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong.
Hong Kong Med J. 2022 Feb;28(1):64-72. doi: 10.12809/hkmj209033. Epub 2021 Jan 28.
Intensive care is expensive, and the numbers of intensive care unit (ICU) beds and trained specialist medical staff able to provide services in Hong Kong are limited. The most recent increase in coronavirus disease 2019 (COVID-19) infections over July to August 2020 resulted in more than 100 new cases per day for a prolonged period. The increased numbers of critically ill patients requiring ICU admission posed a capacity challenge to ICUs across the territory, and it may be reasonably anticipated that should a substantially larger outbreak occur, ICU services will be overwhelmed. Therefore, a transparent and fair prioritisation process for decisions regarding patient ICU admission is urgently required. This triage tool is built on the foundation of the existing guidelines and framework for admission, discharge, and triage that inform routine clinical practice in Hospital Authority ICUs, with the aim of achieving the greatest benefit for the greatest number of patients from the available ICU resources. This COVID-19 Crisis Triage Tool is expected to provide structured guidance to frontline doctors on how to make triage decisions should ICU resources become overwhelmed by patients requiring ICU care, particularly during the current COVID-19 pandemic. The triage tool takes the form of a detailed decision aid algorithm based on a combination of established prognostic scores, and it should increase objectivity and transparency in triage decision making and enhance decision-making consistency between doctors within and across ICUs in Hong Kong. However, it remains an aid rather than a complete substitute for the carefully considered judgement of an experienced intensive care clinician.
重症监护费用高昂，而香港的重症监护病房（ICU）床位和能够提供服务的专业医疗人员数量有限。2020 年 7 月至 8 月，香港新冠病毒病（COVID-19）感染人数最近有所增加，每天新增病例超过 100 例，持续时间较长。需要入住 ICU 的危重症患者人数增加，对全港 ICU 造成了容量挑战，如果发生更大规模的疫情爆发，预计 ICU 服务将不堪重负。因此，迫切需要建立一个透明和公平的决策程序，对 ICU 患者入院进行优先排序。该分诊工具建立在现有的 ICU 收治、出院和分诊指南和框架的基础上，旨在从现有的 ICU 资源中为尽可能多的患者提供最大的获益。该 COVID-19 危机分诊工具预计将为一线医生提供结构化指导，以便在 ICU 资源因需要 ICU 护理的患者而不堪重负时做出分诊决策，特别是在当前 COVID-19 大流行期间。该分诊工具采用详细的决策辅助算法形式，基于既定的预后评分组合，它应该提高分诊决策的客观性和透明度，并增强香港各 ICU 内部和之间医生之间的决策一致性。然而，它仍然只是一种辅助手段，而不是经验丰富的重症监护临床医生精心考虑判断的完全替代品。
