Résumés
Abstract
During COVID-19, most intensive care units (ICUs) in Canada implemented strategies to manage a surge in demand for critical care to avoid turning people away, termed “triage-avoidant strategies.” These strategies, including redeploying non-ICU staff to the ICU to increase patient capacity, and transferring people over long distances to available beds, may have caused negative consequences for patients, healthcare staff, and equity-deserving groups. This study explores the perspectives of equity-deserving groups and organizations on triage-avoidant strategies during COVID-19, examined organization-specific responses, and identified system-level recommendations to improve equity, access, and preparedness. A qualitative descriptive study was conducted between July and December 2023 across five provinces in Canada. Participants, including staff from organizations serving equity-deserving groups, as well as government and healthcare representatives, were recruited through professional networks and snowball sampling. A semi-structured interview guide was used to elicit perspectives, which were then analyzed inductively using thematic analysis. 23 individuals from Ontario (n=12), British Columbia (n=4), Saskatchewan (n=4), Nova Scotia (n=2) and New Brunswick (n=1) participated. 15 participants (65%) identified as persons of colour or among equity-deserving groups; 13 (57%) participants worked within organizations representing decision-makers, clinicians, and/or equity-deserving groups. We identified three themes: 1) Triage-avoidant strategies were perceived to have disproportionately harmful effects on equity-deserving groups and healthcare providers; 2) organizations acted to mitigate effects of triage-avoidant strategies; and 3) various system-level actions could help mitigate the perceived effects of these strategies in future surges in demand. This study contributes to the literature by incorporating perspectives of representatives from diverse organizations and equity-deserving groups on how triage-avoidant strategies disproportionately harmed the populations they serve. Our findings can inform the development/implementation of triage-avoidant strategies that mitigate the perceived harmful effects on decision-makers, clinicians, and equity-deserving groups, while promoting equitable care.
Keywords:
- COVID-19,
- health equity,
- intensive care units,
- pandemic,
- public health ethics,
- public health emergency,
- resource allocation,
- triage
Résumé
Pendant la COVID-19, la plupart des unités de soins intensifs (USI) au Canada ont mis en place des stratégies pour gérer une hausse de la demande en soins critiques afin d’éviter de refuser des patients, appelées stratégies d’évitement du triage. Ces stratégies, notamment la réaffectation de personnel non spécialisé en soins intensifs vers les USI pour augmenter la capacité d’accueil, ainsi que le transfert de patients sur de longues distances vers des lits disponibles, ont pu entraîner des conséquences négatives pour les patients, le personnel de santé et les groupes en quête d’équité. Cette étude explore les perspectives de ces groupes et des organisations qui les représentent concernant les stratégies d’évitement du triage durant la COVID-19, examine les réponses propres aux organisations et identifie des recommandations à l’échelle du système pour améliorer l’équité, l’accès et la préparation. Une étude qualitative descriptive a été menée entre juillet et décembre 2023 dans cinq provinces canadiennes. Les participants, incluant du personnel d’organisations au service des groupes en quête d’équité ainsi que des représentants gouvernementaux et du secteur de la santé, ont été recrutés par le biais de réseaux professionnels et d’un échantillonnage boule de neige. Un guide d’entretien semi-structuré a été utilisé pour recueillir les points de vue, qui ont ensuite été analysés de manière inductive à l’aide d’une analyse thématique. Au total, 23 personnes provenant de l’Ontario (n=12), de la Colombie-Britannique (n=4), de la Saskatchewan (n=4), de la Nouvelle-Écosse (n=2) et du Nouveau-Brunswick (n=1) ont participé. Quinze participants (65 %) se sont identifiés comme personnes racisées ou appartenant à des groupes en quête d’équité; 13 (57 %) travaillaient au sein d’organisations représentant des décideurs, des cliniciens et/ou des groupes en quête d’équité. Trois thèmes ont été identifiés : 1) les stratégies d’évitement du triage ont été perçues comme ayant des effets disproportionnellement néfastes sur les groupes en quête d’équité et les professionnels de la santé; 2) les organisations ont agi pour atténuer les effets de ces stratégies; et 3) diverses actions à l’échelle du système pourraient contribuer à atténuer les effets perçus de ces stratégies lors de futures hausses de la demande. Cette étude apporte une contribution originale à la littérature en intégrant les perspectives de représentants d’organisations diverses et de groupes en quête d’équité sur la manière dont les stratégies d’évitement du triage ont causé des préjudices disproportionnés aux populations qu’ils desservent. Nos résultats peuvent éclairer l’élaboration et la mise en œuvre de stratégies d’évitement du triage qui atténuent les effets néfastes perçus sur les décideurs, les cliniciens et les groupes en quête d’équité, tout en favorisant des soins équitables.
Mots-clés :
- COVID-19,
- équité en santé,
- unités de soins intensifs,
- pandémie,
- éthique en santé publique,
- urgence de santé publique,
- allocation des ressources,
- triage
Parties annexes
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