Triaging of Patients in ICU to Reduce MortalityPolicy Background (evidence as to why change is needed):

Patients often admitted to intensive care units (ICU) need urgent medical attention and care to
survive, such as those with severe infections that need ventilators to breathe, those with severe
injuries following accidents, those who undergo urgent invasive surgical operations, or those
who have developed complications after surgery (Thompson et al., 2020). The decision to admit
these patients and discharge others can determine death and survival. As such, ICU mortalities
often depend on the decisions clinicians and physicians make during admission. Getting it wrong
can skyrocket the ICU mortalities because those who need urgent care do not receive it in time.
Policy Description:
The ICU triage is a framework or process used to classify patients based on the severity of their
medical conditions, symptoms, and injuries to estimate how urgently and quickly they need
emergency care. In ICU, triaging patients is necessary to ensure that patients with the most
urgent care needs are prioritized and get lifesaving support ahead of those that might wait for a
little. ICU triage serves the ethical purpose of ensuring fairness (Wilkinson, 2020). For this
clinic, determining which patient is admitted to the ICU should be done using computer
simulations. Precisely, heuristic should estimate the patient’s chances of survival, then divide the
figure by the potential number of days individuals would likely stay in the facility to stabilize.
Priority should be given to those with the highest ratios (Daley, 2020).
Implementation Plan
Role of the Nurse Leader in the Implementation Process:

The primary role of the nurse leader is to direct clinical operations and ensure that the policy
achieves the desired patient outcomes – reduce mortalities. This includes supplying all nurses
and team members with the tools and knowledge required to effectively triage patients and
address mortalities. The nurse leader also oversees patient education and training.
Role of the Nurse Manager in the Implementation Process:

Unlike the nurse leader, who is concerned more with patient outcomes, the nurse manager
performs general administrative functions, such as drafting the budget needed to implement the
policy, training and supervising ICU team members, evaluating members’ performance, and
purchasing equipment and tools the project requires.
Role of the Patient in the Implementation Process:
As the recipients of the policy program, patient responsibilities include complying with the
triaging decisions made by clinicians, accepting outcomes, providing information when
requested, following program regulations and rules, meeting financial obligations, and showing
thoughtfulness and respect (Visser & Monetjano, 2015).
Implementation
Competency
Elaborate on the role of the nurse manager, nurse leader, and the patient in the implementation
process of the policy.
Scholarly resources are used to support ideas.

Evaluation Plan
List at least two expected measurable changes in healthcare outcomes based on policy
implementation:

1. Mortality rates
   Mortality rates will be measured by dividing the number of casualties recorded in the ICU by at-
   risk population admitted within a specified period (for example, two months from policy
   implementation).
2. Recovery rates
   Recovery rates will be measured by dividing the number of patients dispatched from the ICU
   (recovered patients) by at-risk population admitted within a specific period (for example, two
   months from policy implementation).

Considerations

1. Discuss two potential cultural considerations for the implementation of this policy.
   The two cultural considerations for the implementation of the policy include the language barrier
   and racial discrimination.
   A language barrier can affect communication with patients, leading to biased triaging. The
   language barrier can create bias in triaging due to miscommunication between the providers
   performing the triaging and patients. Specifically, miscommunication can deny nurses the ability

to collect accurate patient histories and critical information related to their conditions, symptoms,
signs, and medication history. This data is what providers use in triaging patients. Inaccurate
information can mean that patients are disproportionately triaged. Racial/ethnic differences can
also lead to disproportionate triaging. For example, white nurses and the facility can prioritize
white patients over other genuinely needy or at-risk patients, such as African Americans and
Latino. Racial discrimination is a significant issue in triaging can mean that patients that do not
urgently need critical care are triaged first, leaving out vulnerable patients. If not addressed, the
language barrier and racial discrimination can result in higher mortalities among those
discriminated against but genuinely need critical care (Vigil et al., 2016).

References

Daley, J. (2020, Mar. 20). How to triage patients who need intensive care. Scientific American.
https://www.scientificamerican.com/article/how-to-triage-patients-who-need-intensive-
care/#
Thompson, R. J., et al. (2020). Clinical characteristics and outcomes of critically ill patients with
COVID-19 admitted to an intensive care unit in London: A prospective observational
cohort study. PLoS One, 15(12), e0243710. doi: 10.1371/journal.pone.0243710
Vigil, J. M. (2016). Patient ethnicity affects triage assessments and patient prioritization in the
U.S. Department of Veterans Affairs Emergency Department. Medicine, 95(14). doi:
10.1097/MD.0000000000003191
Visser, S., & Monetjano, A. S. (2015). Fast facts for the triage nurse: An orientation and care
guide in a nutshell. Springer Publishing Company.

Wilkinson, D. (2020). ICU triage in an impending crisis: Uncertainty, pre-emption, and
preparation. Journal of Medical Ethics, 46(5), 287-288. doi: 10.1136/med ethics-2020-
106226