Working Group for Health Care Operations/Health Information Management, Faculty of Business and Economics, Faculty of Medicine, University of Augsburg, Universitätsstr. 16, 86159, Augsburg, Germany.
Professor of Decision Science in Healthcare, Department of Technology, Management, and Economics, Technical University of Denmark, Lyngby, Denmark.
Anaesthesiologie. 2023 Dec;72(Suppl 1):10-18. doi: 10.1007/s00101-023-01336-7. Epub 2023 Sep 21.
The significant increase in patients during the COVID-19 pandemic presented the healthcare system with a variety of challenges. The intensive care unit is one of the areas particularly affected in this context. Only through extensive infection control measures as well as an enormous logistical effort was it possible to treat all patients requiring intensive care in Germany even during peak phases of the pandemic, and to prevent triage even in regions with high patient pressure and simultaneously low capacities. Regarding pandemic preparedness, the German Parliament passed a law on triage that explicitly prohibits ex post (tertiary) triage. In ex post triage, patients who are already being treated are included in the triage decision and treatment capacities are allocated according to the individual likelihood of success. Legal, ethical, and social considerations for triage in pandemics can be found in the literature, but there is no quantitative assessment with respect to different patient groups in the intensive care unit. This study addressed this gap and applied a simulation-based evaluation of ex ante (primary) and ex post triage policies in consideration of survival probabilities, impairments, and pre-existing conditions. The results show that application of ex post triage based on survival probabilities leads to a reduction in mortality in the intensive care unit for all patient groups. In the scenario close to a real-world situation, considering different impaired and prediseased patient groups, a reduction in mortality of approximately 15% was already achieved by applying ex post triage on the first day. This mortality-reducing effect of ex post triage is further enhanced as the number of patients requiring intensive care increases.
在 COVID-19 大流行期间，患者数量显著增加，使医疗系统面临各种挑战。重症监护病房是受影响特别大的领域之一。只有通过广泛的感染控制措施和巨大的后勤努力，才有可能在德国大流行高峰期治疗所有需要重症监护的患者，并防止分诊，即使在患者压力高且同时容量低的地区也是如此。关于大流行的准备工作，德国议会通过了一项关于分诊的法律，明确禁止事后（三级）分诊。在事后分诊中，已经接受治疗的患者被纳入分诊决策，并根据个体成功的可能性分配治疗能力。关于大流行分诊的法律、伦理和社会考虑因素在文献中有所体现，但在重症监护病房的不同患者群体中没有进行定量评估。本研究解决了这一差距，并应用基于模拟的评估来考虑生存概率、损伤和预先存在的疾病，对事前（一级）和事后分诊政策进行评估。结果表明，基于生存概率应用事后分诊可降低所有患者群体的重症监护死亡率。在接近现实情况的情况下，考虑到不同受损和患病前的患者群体，在第一天应用事后分诊，死亡率已经降低了约 15%。随着需要重症监护的患者数量增加，事后分诊的这种降低死亡率的效果进一步增强。
