Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors

Ann Intern Med. 2020 Aug 4;173(3):188-194. doi: 10.7326/M20-1738. Epub 2020 Apr 24.


Background: The coronavirus disease 2019 pandemic has or threatens to overwhelm health care systems. Many institutions are developing ventilator triage policies.

Objective: To characterize the development of ventilator triage policies and compare policy content.

Design: Survey and mixed-methods content analysis.

Setting: North American hospitals associated with members of the Association of Bioethics Program Directors.

Participants: Program directors.

Measurements: Characteristics of institutions and policies, including triage criteria and triage committee membership.

Results: Sixty-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.

Limitation: The results may not be generalizable to institutions without academic bioethics programs.

Conclusion: Over one half of respondents did not have ventilator triage policies. Policies have substantial heterogeneity, and many omit guidance on fair implementation.

Primary funding source: None.

MeSH terms

  • Betacoronavirus
  • Bioethics
  • COVID-19
  • Coronavirus Infections / therapy*
  • Health Policy
  • Hospitals
  • Humans
  • Pandemics
  • Pneumonia, Viral / therapy*
  • Respiration, Artificial / ethics*
  • Respiration, Artificial / standards*
  • SARS-CoV-2
  • Surveys and Questionnaires
  • Triage / ethics*
  • Triage / standards*
  • United States
  • Ventilators, Mechanical / supply & distribution