SRA and Triage Team Experiences: Insights and Challenges
In this informative collection of experiences from SRA and Triage teams in Cincinnati, Ann Arbor, and Central Texas, key ethical issues and operational dilemmas are discussed. The evolving landscape of COVID-19 presents unique challenges that prompt reflection and adaptation. Explore real-life scenarios and ethical considerations faced by healthcare professionals dealing with crisis standards and resource allocation decisions in the midst of the pandemic.
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SRA and Triage Teams Experiences from the Field Carla Nadeja, RHIA (IEPO), Cincinnati Carla.Nadeja@va.gov Ann Marcellino, JD (IEPO), Ann Arbor Ann.Marcellino@va.gov Robert Sebesta, LSCW, HEC-C (IEPO), Central Texas Robert.Sebesta@va.gov Cindy Geppert, MD Cynthia.Geppert@va.gov Barbara L. Chanko, RN MBA Barbara.Chanko@va.gov National Center for Ethics in Health Care July 23, 2020 National Center for Ethics in Health Care National Center for Ethics in Health Care 1 1
Agenda 1. Mini-Reflection 2. Experiences from SRA and Triage Teams a. Cincinnati b. Ann Arbor c. Central Texas 3.Emerging Ethics Issue/Breaking News in COVID-19 4. Questions National Center for Ethics in Health Care 2
Kindness in COVID-19 Recognize we are all under chronic stress Lower your expectations of yourself and others Take relaxation seriously Be aware of your situation but don t dwell on doom Be gentle with yourself above all National Center for Ethics in Health Care 3
SRA and Triage Team Experiences from Cincinnati, OH National Center for Ethics in Health Care 4
SRA and Triage Team Experiences from Cincinnati, OH When do we activate crisis standards? When there is a percentage ICU occupancy (80%)? National Center for Ethics in Health Care 5
SRA and Triage Team Experiences from Cincinnati, OH Would there be alternate criteria to use if a surge should arise and providers cannot enter a consult? National Center for Ethics in Health Care 6
SRA and Triage Team Experiences from Cincinnati, OH How will the care team implement the allocation decisions when there is a change in the resources allocated to a particular patient? For example, when a patient is triaged to the blue priority category and a patient in the red priority category is assigned to the resource. National Center for Ethics in Health Care 7
SRA and Triage Team Experiences from Ann Arbor, MI National Center for Ethics in Health Care 8
VA Ann Arbor Scarce Resource Allocation Team National Center for Ethics in Health Care 9
VA Ann Arbor Scarce Resource Allocation Team Agenda Page 1 National Center for Ethics in Health Care 10
VA Ann Arbor Scarce Resource Allocation Team Agenda Page 2 National Center for Ethics in Health Care 11
VA Ann Arbor Scarce Resource Allocation Team Daily Report National Center for Ethics in Health Care 12
SRA and Triage Team Experiences from Central Texas Veterans HCS National Center for Ethics in Health Care 13
SRA Triage Tool - Tool is only used during crisis standards of care - Utilizes triage protocol directed by the 04/08/2020 memo from the Executive in Charge - Demo scenario based on NCEHC IF Call 04/20/2020 - Demo patient IDs are fabricated and do not represent actual patients National Center for Ethics in Health Care 14
LIVE DEMO National Center for Ethics in Health Care 15
Initial SRA Triage Assessment - Open blank SRA Triage Assessment Tool National Center for Ethics in Health Care 16
Initial SRA Triage Assessment - SRA consult information entered into the tool - Priority level is designated automatically based on triage criterion National Center for Ethics in Health Care 17
Initial SRA Triage Assessment - Click Re-sort Table to sort by priority category National Center for Ethics in Health Care 18
Initial SRA Triage Assessment - Enter first round of decisions - Enter ICU patients in the red and yellow category to the resource list; will be reassessed at 48 hours National Center for Ethics in Health Care 19
Initial SRA Triage Assessment - Enter remaining red priority patients in random selection tool, click button below Copy randomly ranked patients to resource list, add remaining yellow priority patients Complete decisions column (patients below the bold line will be waitlisted) - - National Center for Ethics in Health Care 20
Initial SRA Triage Assessment - Click signature box and sign with PIV card National Center for Ethics in Health Care 21
Initial SRA Triage Assessment - Save to protected shared folder - Other SRA triage team members open the document and add signatures National Center for Ethics in Health Care 22
Initial SRA Triage Assessment - - Changes after any signature will remove all signatures Last signer saves tool as a PDF, Excel document maintained for reassessment National Center for Ethics in Health Care 23
SRA Triage Assessment Tool Update - Prior to saving the Excel tool for continued use: - Remove blue category patients - Delete single organ failure column - Update location for Patients moved to ICU - Move Reassessment SOFA score to Previous SOFA - Clear Decision columns and Random Selection Tools National Center for Ethics in Health Care 24
SRA Triage Assessment Tool - Save the updated Excel version of the tool National Center for Ethics in Health Care 25
Emerging Issues/Breaking News VHA Handbook 1004.01, Informed Consent for Clinical Treatments and Procedures, amended and published on June 25, 2020 aligns with the Interim Final Rule (IFR) for 38 CFR Part 17, Informed Consent and Advance Directives, that took effect on May 27, 2020. iMedConsent Web will be deployed in August for obtaining signature informed consent. Link to Improvement Forum (IF) call from Monday, 7/20/20 for details: https://vaww.infoshare.va.gov/sites/ietechassist/Lists/TA%20Call .%20Documents/Allitemsg.aspx for details. National Center for Ethics in Health Care 26
Ethics Resources for COVID-19 Pandemic Response https://vaww.ethics.va.gov/activities/pandemic/ Ethics_Response.asp National Center for Ethics in Health Care 27
Polls Please click on the poll icon to enter your feedback National Center for Ethics in Health Care 28
Questions from the Field ? National Center for Ethics in Health Care 29
Kindness in COVID-19 Recognize we are all under chronic stress Lower your expectations of yourself and others Take relaxation seriously Be aware of your situation but don t dwell on doom Be gentle with yourself above all National Center for Ethics in Health Care 30
