Ethical perspectives on pre-hospital triage mechanisms among Swiss healthcare stakeholders during times of medical resource scarcity: A qualitative study

Abstract

The coronavirus disease 2019 (COVID-19) pandemic placed Switzerland's healthcare system into an extraordinary situation, creating a profound ethical challenge of deciding which patients to treat. While in-hospital triage received much attention, little is known about pre-hospital triage and its ethical implications. The purpose of our study was to explore the perceptions of stakeholders involved in Swiss healthcare regarding pre-hospital triage during the COVID-19 pandemic in Switzerland, with a particular focus on how it affected the treatment and care of older people during times of resource scarcity. We conducted 57 qualitative interviews with such stakeholders and analysed them with reflexive thematic analysis. We identified three main themes (1) ‘Tracing pre-hospital triage’ captures participants’ reflections on how hospital access may have been restricted before patient arrival; (2) ‘Exploring pre-hospital Silent Triage’ outlines, based on participants’ assumptions and explanations, the occurrence of Silent Triage; (3) In ‘Examining concrete mechanisms of pre-hospital triage’ we refer to explicit actions taken to avoid hospitalization. Although many participants believed urgent hospitalization was always available, our study highlights signs of Silent Triage. These were mainly based on our participants’ descriptions about the persistent concern over the potential to overload the healthcare system and their suspicions of self-triage among older adults. To prevent future Silent Triage, it is imperative to make real-time hospital data on capacity available and to ensure public communication that affirms equal access to care.