The draft emergency triage document, which is now being sent across NHS hospitals in the UK, details how patients should be selected using an ‘ethical system’ in the event that there are insufficient resources available.
The protocol, which was drafted by medical, legal and palliative care specialists at the Royal United Hospital Bath NHS Trust, explains how patients could be selected by their potential to contribute to society and their survival chances.
It comes as NHS data revealed the number of patients waiting more than an hour to be handed to hospitals in England increased from 273 on December 13 to 591 on December 27 – an increase of more than 100 per cent.
Patients seeking treatment for coronavirus could be selected by ‘lottery’, according to a draft emergency triage document by specialists at the Royal United Hospital Bath NHS Trust. Pictured: Workers transfer a patient from ambulance to the Royal London Hospital in London
In the event that hospitals are left overwhelmed, the document states that doctors should consult a ‘four-stage process’ to decide who should get treatment.
Healthcare workers will need to access the patient’s survival chances and any existing conditions they might have, the views of the patient and their family and also aim to ‘save more lives and more years of life’.
They will also have to consult a senior clinician who is not involved in providing care for the patient.
In the document, which was originally published in the Journal for Medical Ethics, the authors of the protocol write: ‘This document is explicitly and only for use in times of inadequate resource, during which we need to change approach, and need a strong ethical framework in order to make fair decisions.
‘When resources are sufficient, decisions are based solely on what is best for each individual patient.
‘When resources are insufficient, decisions need to include a broader view on what is ethically fair for the wider community (society). This means factors such as fairness to others are included in decision-making.
‘This document has been produced locally as there is no explicit national guidance.’
The document goes on to explain that doctors will need to talk through options with the patient and their family and ‘discuss the ethics of the wider situation’.
London is now the epicentre of the outbreak and its hospitals are being stretched with the flood of patients. The weekly rate of cases is double the national average at 858 per 100,000
Doctors will have to consult a ‘four-stage process’ to decide who should get treatment in the event of an emergency. Pictured: A medical team assists a patient into an ambulance outside the Royal London Hospital
It continues: ‘In summary, assess which treatment options are likely to provide meaningful benefit, discuss those options with patient and family/carers to obtain their views on the benefits and burdens of each option, discuss the ethics of the wider situation and combine this in an overall clinician judgement.
‘It is important to note that these decisions are of high consequence, stressful to make and often time-sensitive.
‘Assessments need appropriate time and thought and should generally not be made at the bedside. Staff making the decisions may find the process highly stressful and access to Trust support through the Trauma Risk Management (TRiM) process is encouraged.
‘While there is no formal ”triage team”, the full assessment requires three senior clinicians, at least one of whom is not directly involved in the patient’s care.’
The protocol adds: ‘For patients with similar prognosis, who cannot be separated in other ways (eg, by all four parts of the assessment), a random allocation, such as a lottery, may be used. The four-stage assessment means this is likely to be rarely required.’
NHS doctor Moosa Qureshi, said they were ‘appalled’ that doctors were having to draw up their own guidelines.
Slides presented at the briefing showed that one in 50 people in England are thought to be infected with coronavirus
He told The Telegraph: ‘We are appalled that NHS doctors are now having to draw up their own guidelines as a direct consequence of the Health Secretary’s abdication of responsibility.
‘Ad hoc policy-making driven by clinical teams within individual NHS trusts – no matter how good – is the inevitable response to lack of leader- ship at a national level, but will lead to inconsistency, inefficiency and large numbers of avoidable deaths’.
It comes as figures revealed that the number of patients being forced to wait in ambulances is soaring amid rising hospital admissions.
NHS data shows that the number of patients waiting more than an hour to be handed to hospitals in England increased from 273 on December 13 to 591 on December 27 – an increase of more than 100 per cent.
As the number of cases continue to rise, trusts in London and the south-east at the centre of the UK’s epidemic are preparing to transfer patients to hospitals in the south-west while patients in the east of England will be moved to the Midlands.
The massive Nightingale hospital at the London Excel Centre, which was created in record-time early in the pandemic only to be swiftly mothballed, is also expected to reopen within a fortnight, the Times reports.