• AntommariaArmand H MathenyAHMEthics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, University of Cincinnati School of Medicine, Cincinnati, Ohio (A.H.A.)., Tyler S Gibb, Amy L McGuire, Paul Root Wolpe, Matthew K Wynia, Megan K Applewhite, Arthur Caplan, Douglas S Diekema, D Micah Hester, Lisa Soleymani Lehmann, Renee McLeod-Sordjan, Tamar Schiff, Holly K Tabor, Sarah E Wieten, Jason T Eberl, and Task Force of the Association of Bioethics Program Directors.
• Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, University of Cincinnati School of Medicine, Cincinnati, Ohio (A.H.A.).
• Ann. Intern. Med. 2020 Aug 4; 173 (3): 188194188-194.

BackgroundThe coronavirus disease 2019 pandemic has or threatens to overwhelm health care systems. Many institutions are developing ventilator triage policies.ObjectiveTo characterize the development of ventilator triage policies and compare policy content.DesignSurvey and mixed-methods content analysis.SettingNorth American hospitals associated with members of the Association of Bioethics Program Directors.ParticipantsProgram directors.MeasurementsCharacteristics of institutions and policies, including triage criteria and triage committee membership.ResultsSixty-seven program directors responded (response rate, 91.8%); 36 (53.7%) hospitals did not yet have a policy, and 7 (10.4%) hospitals' policies could not be shared. The 29 institutions providing policies were relatively evenly distributed among the 4 U.S. geographic regions (range, 5 to 9 policies per region). Among the 26 unique policies analyzed, 3 (11.3%) were produced by state health departments. The most frequently cited triage criteria were benefit (25 policies [96.2%]), need (14 [53.8%]), age (13 [50.0%]), conservation of resources (10 [38.5%]), and lottery (9 [34.6%]). Twenty-one (80.8%) policies use scoring systems, and 20 of these (95.2%) use a version of the Sequential Organ Failure Assessment score. Among the policies that specify the triage team's composition (23 [88.5%]), all require or recommend a physician member, 20 (87.0%) a nurse, 16 (69.6%) an ethicist, 8 (34.8%) a chaplain, and 8 (34.8%) a respiratory therapist. Thirteen (50.0% of all policies) require or recommend that those making triage decisions not be involved in direct patient care, but only 2 (7.7%) require that their decisions be blinded to ethically irrelevant considerations.LimitationThe results may not be generalizable to institutions without academic bioethics programs.ConclusionOver one half of respondents did not have ventilator triage policies. Policies have substantial heterogeneity, and many omit guidance on fair implementation.Primary Funding SourceNone.

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