When catastrophic disasters strike, health care systems are often faced with overwhelming volumes of patients to treat (patient surge). While many governmental and policy organizations have outlined recommendations to build surge capacity, there has been little research on specific strategies to accommodate these significant patient loads. Specifically, a concept known as reverse triage, which allows clinicians to assess current patients for possible discharge or reduction in the level of their clinical care, is still poorly understood. This research study investigated the utility of a structured assessment tool to predict the ability of a current patient to be discharged or downgraded in the event of a catastrophic disaster. Clinicians were provided a mock scenario and asked to use their clinical judgment or a structured assessment tool. The charts of patients were then reviewed 96 hours after the assessments were completed to determine whether predictions were accurate. This pilot study showed that the assessment tool was slightly better at predicting which patients could be safely discharged and which needed to remain admitted. This project serves as a first foray of research into this area and will initiate broader discourse and additional studies. The goal is to provide clinicians with stronger guidance vetted in scientific evidence and supported in ethical, legal, and moral context to make difficult decisions in the face of catastrophic disaster situations.
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