Transparent triage policies during the COVID‐19 pandemic: a critical part of medico‐legal risk management for clinicians

Close, Eliana; Willmott, Lindy; Cockburn, Tina; Young, Simon; Cairns, Will; White, Benjamin P.

doi:10.5694/mja2.51079

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…Transcribing in the medical record the disinfection of the environments, the sterilization of surgical instruments, the sterilization of the operating field, and the appropriate use of PPE plays a crucial role in preventing malpractice litigation, also in the field of vaccinations. Transparency, communication with relatives and patients, trust between them and healthcare professionals play another fundamental role in preventing the risk of COVID-19 infection within hospitals [ 120 ]. Another interesting aspect is to encourage telemedicine in order to guarantee care for people who do not want to, or cannot, access hospitals, continue to perform follow-up, as well as avoiding diagnostic delays, and decreasing the correlated HAI due to COVID-19.…”

Section: The Scovid-19 Pandemic and Its Impact On Forensic Investigat...mentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on the Practice of Forensic Medicine: An Overview

et al. 2022

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During the COVID-19 pandemic, forensic sciences, on the one hand, contributed to gaining knowledge about different aspects of the pandemic, while on the other hand, forensic professionals were called on to quickly adapt their activities to respond adequately to the changes imposed by the pandemic. This review aims to clarify the state of the art in forensic medicine at the time of COVID-19, discussing the following: the influence of external factors on forensic activities, the impact of autopsy practice on COVID-19 and vice-versa, the persistence of SARS-CoV-2 RNA in post-mortem samples, forensic personnel activities during the SARS-CoV-2 pandemic, the global vaccination program and forensic sciences, forensic undergraduate education during and after the imposed COVID-19 lockdown, and the medico-legal implications in medical malpractice claims during the COVID-19 pandemic. The COVID-19 pandemic has greatly influenced different aspects of human life, and, accordingly, the practical activities of forensic sciences that are defined as multidisciplinary, involving different expertise. Indeed, the activities are very different, including crime scene investigation (CSI), external examination, autopsy, and genetic and toxicological examinations of tissues and/or biological fluids. At the same time, forensic professionals may have direct contact with subjects in life, such as in the case of abuse victims (in some cases involving children), collecting biological samples from suspects, or visiting subjects in the case of physical examinations. In this scenario, forensic professionals are called on to implement methods to prevent the SARS-CoV-2 infection risk, wearing adequate PPE, and working in environments with a reduced risk of infection. Consequently, in the pandemic era, the costs involved for forensic sciences were substantially increased.

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Section: The Scovid-19 Pandemic and Its Impact On Forensic Investigat...mentioning

confidence: 99%

The Impact of the COVID-19 Pandemic on the Practice of Forensic Medicine: An Overview

et al. 2022

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Section: Discussionmentioning

confidence: 99%

“…Although Australia and New Zealand have evaded the magnitude of the pandemic that has overwhelmed healthcare systems in many parts of the world, our study has demonstrated that intensive care teams have been selective in admitting frail patients with COVID‐19 into their ICUs. Close and colleagues reported on some reluctance and lack of transparency from governments to develop and/or release standardized triaging guidelines before another pandemic crisis wave 37 …”

Section: Discussionmentioning

confidence: 99%

“…Close and colleagues reported on some reluctance and lack of transparency from governments to develop and/or release standardized triaging guidelines before another pandemic crisis wave. 37 A recent study, although not specific to patients with COVID-19, reported on many frailty-specific integrated care models to support the care of frail older people in hospitals and the community in their horizon-scanning review. 38 Such integrated models could potentially reduce the number of frail older people requiring ICU and may improve outcomes also for those who eventually are admitted to and discharged from ICU.…”

Section: Relationship To Previous Studiesmentioning

confidence: 99%

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Treatment limitations and clinical outcomes in critically ill frail patients with and without COVID‐19 pneumonitis

Subramaniam

Tiruvoipati

Pilcher

et al. 2022

J American Geriatrics Society

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Background The presence of treatment limitations in patients with frailty at intensive care unit (ICU) admission is unknown. We aimed to evaluate the presence and predictors of treatment limitations in patients with and without COVID‐19 pneumonitis in those admitted to Australian and New Zealand ICUs. Methods This registry‐based multicenter, retrospective cohort study included all frail adults (≥16 years) with documented clinical frailty scale (CFS) scores, admitted to ICUs with admission diagnostic codes for viral pneumonia or acute respiratory distress syndrome (ARDS) over 2 years between January 01, 2020 and December 31, 2021. Frail patients (CFS ≥5) coded as having viral pneumonitis or ARDS due to COVID‐19 were compared to those with other causes of viral pneumonitis or ARDS for documented treatment limitations. Results 884 frail patients were included in the final analysis from 129 public and private ICUs. 369 patients (41.7%) had confirmed COVID‐19. There were more male patients in COVID‐19 (55.3% vs 47.0%; p = 0.015). There were no differences in age or APACHE‐III scores between the two groups. Overall, 36.0% (318/884) had treatment limitations, but similar between the two groups (35.8% [132/369] vs 36.1% [186/515]; p = 0.92). After adjusting for confounders, increasing frailty (OR = 1.72; 95%‐CI 1.39–2.14), age (OR = 1.05; 95%‐CI 1.04–1.06), and presence of chronic respiratory condition (OR = 1.58; 95%‐CI 1.10–2.27) increased the likelihood of instituting treatment limitations. However, the presence of COVID‐19 by itself did not influence treatment limitations (odds ratio [OR] = 1.39; 95%‐CI 0.98–1.96). Conclusions The proportion of treatment limitations was similar in patients with frailty with or without COVID‐19 pneumonitis at ICU admission.

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“…Poor regulation can also lead to adverse outcomes for health professionals. Unclear law, policy, or guidelines can introduce legal, ethical, and other risks or harms into decision-making for health professionals (Hawryluck, Oczkowski, and Handelman 2016;Downar, Warner, and Sibbald 2016; Department of Health (NSW) 2010; Close et al 2021). One example is health professionals who are "accidental noncompliers": those who intend to comply with the law (an advance directive in this study) but the law's complexity or counter-intuitive position means they that they inadvertently do not (White et al 2017b).…”

Section: Current Regulation Of End-of-life Care Is Flawedmentioning

confidence: 99%

Better Regulation of End-Of-Life Care: A Call For A Holistic Approach

White

Willmott

2022

Bioethical Inquiry

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Existing regulation of end-of-life care is flawed. Problems include poorly-designed laws, policies, ethical codes, training, and funding programs, which often are neither effective nor helpful in guiding decision-making. This leads to adverse outcomes for patients, families, health professionals, and the health system as a whole. A key factor contributing to the harms of current regulation is a siloed approach to regulating end-of-life care. Existing approaches to regulation, and research into how that regulation could be improved, have tended to focus on a single regulatory instrument (e.g., just law or just ethical codes). As a result, there has been a failure to capture holistically the various forces that guide end-of-life care. This article proposes a response to address this, identifying “regulatory space” theory as a candidate to provide the much-needed holistic insight into improving regulation of end-of-life care. The article concludes with practical implications of this approach for regulators and researchers.

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Transparent triage policies during the COVID‐19 pandemic: a critical part of medico‐legal risk management for clinicians

Cited by 6 publications

References 10 publications

The Impact of the COVID-19 Pandemic on the Practice of Forensic Medicine: An Overview

The Impact of the COVID-19 Pandemic on the Practice of Forensic Medicine: An Overview

Treatment limitations and clinical outcomes in critically ill frail patients with and without COVID‐19 pneumonitis

Better Regulation of End-Of-Life Care: A Call For A Holistic Approach

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