Re: Covid-19: doctors are given new guidelines on when to admit patients to critical care
Dear Editor
The NICE guidelines on critical care mentioned in this article would place an unfair responsibility upon a single individual (the acute care physician). As is they are already shouldering too many clinical responsibilities. In addition to the physical demands of the job, they are away from family and friends for prolonged periods of time. Moreover, these are not roles that these clinicians signed up for as there’s neither any precedent nor any formal training for the same. In such critical scenarios, to place the added responsibility upon them to make decisions that they have never before had to face, and for which many of them will not be prepared, would be overwhelming.
Responsibility to make such tough decisions should not lie with the acute care clinicians and intensive care teams directly responsible for the clinical care of these patients--rather with an altogether different team composed of personnel who have no clinical responsibilities to these particular cohorts of patients called a “triage committee”. This committee may be constituted by senior clinicians and emeritus professors from the medical field. The committed may also include or engage with leaders from the locality that the community trusts. The committee could also be given the added responsibilities to discuss with elderly patients and families “do not resuscitate” protocols/orders before they become acutely ill.
Improvising the present triage concept to “forward triage” would not only enhance the efficiency of intensive care units but also ensure better commitment from acute care physicians.
I was working at the National University Hospital Singapore during the outbreak of severe acute respiratory syndrome (SARS) from 1 March to 11 May 2003. At that time, nothing was known about the aetiological agent of the atypical pneumonia that was termed SARS. Transmission within the healthcare and household settings accounted for more than 90% of cases.
Experience at that time taught us that "Running normal hospital services are difficult while managing a large number of patients with SARS or exposure to SARS".
I wish to share an article Sars Transmission and Hospital Containment. [1]
References:
1. Gowri Gopalakrishna, Philip Choo, Yee Sin Leo, et al. Sars Transmission and Hospital Containment Emerg Infect Dis. 2004 Mar; 10(3): 395–400. doi: 10.3201/eid1003.030650
Competing interests:
No competing interests
08 April 2020
Jahoorahmad Patankar
General Pediatric Surgeon
Dr L H Hiranandani Hospital, Mumbai
202 Cliff Tower Apts, III Cross Road, Samarth Nagar Lokhandwala Complex Andheri West Mumbai 400053. India
Rapid Response:
Re: Covid-19: doctors are given new guidelines on when to admit patients to critical care
Dear Editor
The NICE guidelines on critical care mentioned in this article would place an unfair responsibility upon a single individual (the acute care physician). As is they are already shouldering too many clinical responsibilities. In addition to the physical demands of the job, they are away from family and friends for prolonged periods of time. Moreover, these are not roles that these clinicians signed up for as there’s neither any precedent nor any formal training for the same. In such critical scenarios, to place the added responsibility upon them to make decisions that they have never before had to face, and for which many of them will not be prepared, would be overwhelming.
Responsibility to make such tough decisions should not lie with the acute care clinicians and intensive care teams directly responsible for the clinical care of these patients--rather with an altogether different team composed of personnel who have no clinical responsibilities to these particular cohorts of patients called a “triage committee”. This committee may be constituted by senior clinicians and emeritus professors from the medical field. The committed may also include or engage with leaders from the locality that the community trusts. The committee could also be given the added responsibilities to discuss with elderly patients and families “do not resuscitate” protocols/orders before they become acutely ill.
Improvising the present triage concept to “forward triage” would not only enhance the efficiency of intensive care units but also ensure better commitment from acute care physicians.
I was working at the National University Hospital Singapore during the outbreak of severe acute respiratory syndrome (SARS) from 1 March to 11 May 2003. At that time, nothing was known about the aetiological agent of the atypical pneumonia that was termed SARS. Transmission within the healthcare and household settings accounted for more than 90% of cases.
Experience at that time taught us that "Running normal hospital services are difficult while managing a large number of patients with SARS or exposure to SARS".
I wish to share an article Sars Transmission and Hospital Containment. [1]
References:
1. Gowri Gopalakrishna, Philip Choo, Yee Sin Leo, et al. Sars Transmission and Hospital Containment Emerg Infect Dis. 2004 Mar; 10(3): 395–400. doi: 10.3201/eid1003.030650
Competing interests: No competing interests