ANZICS CTG Endorsed Study
Influenza Pandemic ICU Triage Study 3
An influenza pandemic has the potential to overwhelm intensive care resources, but the views of the general public on how resources should be allocated in such a scenario are unknown. The Influenza Pandemic ICU Triage Study 3 (iPIT 3) aimed to determine Australian and New Zealand public opinion on how intensive care beds should be allocated during an influenza pandemic.
A postal questionnaire was sent to 4000 registered voters randomly selected from the Australian and New Zealand Electoral Commission rolls. The main outcome measure was the respondents’ preferred method to triage intensive care patients in an influenza pandemic. Respondents chose from six methods: to use a “first in, first served” approach; to allow a senior doctor to decide; to use predetermined health department criteria; to use random selection; to use the patient’s ability to pay; to use the importance of the patient to decide. Respondents also rated each of the triage methods for fairness.
Australian respondents preferred that patients be triaged to the intensive care unit either by a senior doctor (43.2%) or by predetermined health department criteria (38.7%). New Zealand respondents preferred that triage be performed by a senior doctor (45.9%). Respondents from both countries perceived triage by a senior doctor and by predetermined health department criteria to be fair, and the other four methods of triage to be unfair.
Significance of these results
The results showed that in an influenza pandemic where intensive care resources are overwhelmed, intensive care triage by a senior doctor and the use of predetermined triage criteria are likely to be the most acceptable methods to the general public. These results will help inform public policy.
Implications for future research
The problem with the restricting access to intensive care resources in an influenza pandemic is if the process of setting priorities is perceived as being unfair the legitimacy of a public health response may be challenged, and restrictive measures may not be adhered to. The iPIT 3 study provided insight into the views of the general population. The next study in this program (iPIT 4) will determine the views of surrogate decision-makers or next of kin for patients in the ICU who are likely to be directly affected by triage decisions in an influenza pandemic.
Management Committee: Winston Cheung (Chair), John Myburgh, Shay McGuinness, Debra Chalmers, Rachael Parke, Fiona Blyth, Ian Seppelt, Michael Parr, Claire Hooker and Vasi Naganathan.
Administering institution: Concord Repatriation General Hospital, NSW.
Results publication: Cheung W, Myburgh J, McGuinness S, Chalmers D, Parke R, Blyth F, Seppelt I, Parr M, Hooker C, Blackwell N, DeMonte S, Gandhi K, Kol M, Kerridge I, Nair P, Saunders NM, Saxena MK, Thanakrishnan G, Naganathan V, on behalf of the The Influenza Pandemic ICU Triage 3 (iPIT 3) Study Investigators and the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group (CTG). A cross-sectional survey of Australian and New Zealand public opinion on methods to triage intensive care patients in an influenza pandemic. Crit Care Resusc 2017; 19: 254-265.