Putting ICU triage guidelines into practice: A simulation study using observations and interviews

Inger L. Abma; Gert J. Olthuis; Irma T. H. M. Maassen; Marjan L. Knippenberg; Miriam Moviat; Annie J. Hasker; A. G. Buenen; Bernard G. Fikkers; Anke J. M. Oerlemans

doi:10.1371/journal.pone.0286978

Peer Review History

Original SubmissionJune 20, 2022
24 Apr 2023 Decision Letter - Jianhong Zhou, Editor PONE-D-22-16565Putting ICU triage guidelines into practice: a simulation study using observations and interviewsPLOS ONE Dear Dr. Abma, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by May 21 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information. 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. 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I have few comments on the study: Well-developed methodology is there but results are bit confusing, and the numbering mentioned in table 5 are not understandable. More brief points for this should be mentioned. Try to elaborate introduction and discussion part as they are not properly depicting the main theme and results of your done work. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0286978.r001
Revision 1
8 May 2023 Author Response We thank the editor and the reviewers for their helpful comments. Below, a point by point response is provided. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf >> We have made the required adjustments. It should be noted that we have four levels of headings, but we saw no way to reduce this to three levels without making our (rather complicated) results more confusing. We have for now used italics for this fourth level (but can adjust this if needed). We have also used italics for the quotes in the text, so that they are not confused with the main text; as well as for certain phrases that correspond with the main topics that we found to provide more structure in the text. These can be removed if this is desired. We also noted that the numbering for the tables and footnotes in the tables was not always correct. This was also adjusted. 2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information. >> We have added the information that the participants signed written informed consent. The study did not include minors. 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. >> The reference list was checked and was found to be complete and without retracted articles. We made some adjustments to the layout of some of the references and added hyperlinks to (non-article) documents such as guidelines. Reviewer #1: The authors have addressed a very important topic in their research. The article is written in an eye catching manner and are the methodological details have been provided. The results are presented appropriately. Reviewer #2: The topic is very interesting & practical testing of triage guidelines in a scientific study has so far not taken place. The study findings would be helpful for hospitals adapting national guidelines. >> We thank the reviewers for their appreciative comments. I have few comments on the study: Well-developed methodology is there but results are bit confusing, and the numbering mentioned in table 5 are not understandable. More brief points for this should be mentioned. >> We agree that Table 5 is a bit of a puzzle. We only noted down the codes of the cases (rather than a description) because otherwise the table becomes very cluttered. This means the codes have to be explained outside the table. Rather than using footnotes to repeat the information in Table 3 (in which the codes are explained), we have a footnote referring to Table 3. We still believe this is the most elegant way to do it, as the footnotes section is already very long for this table. However, to better aid readers in understanding Table 5 we have added the following: • When referring to Table 5 in the text we directly encourage readers to use Table 3 to understand the codes. P11: Prioritization of patients was similar among the teams, though not exactly the same (Table 5; see Table 3 for case codes). • We have redesigned Table 3 in order to have the codes of the cases stand out more (P9). This should make it easier to look up which case each codes refers to. Additionally, we have made explicit in the title of Table 3 that this table explains the coding system used in the article. We hope that these changes will make Table 5 easier to understand. Additionally, while doing this, we realized that one footnote/explanation was missing from the table. We added this footnote and adjusted the letters of the other footnotes accordingly (the footnotes are also changed from numbers to letters, as per the journal’s style requirements). Try to elaborate introduction and discussion part as they are not properly depicting the main theme and results of your done work. >> We agree that the introduction section should be more elaborate. We have added a paragraph with general information regarding ICU care and COVID-19 patients in the ICU, which we feel will help readers understand the context of our research better (page 1). Regarding the discussion section (currently 1500+ words): after discussion in the research team we remain unsure how we could better depict the main theme and results of our work, as per the reviewer’s request. Currently the discussion section covers our most important findings, compared to international guidelines and literature, and with their practical implications (i.e. need for operationalized guidelines; need for more training of triage teams; need for psychological support for triage teams); as well as a comparison with literature on prioritization in healthcare in general. Unfortunately, we have therefore not been able to add new information to the discussion section based on the reviewer comment. We hope the reviewer will reconsider this aspect of their comment or otherwise share which topics they feel are missing from the discussion section. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0286978.r002
29 May 2023 Decision Letter - Amjad Khan, Editor Putting ICU triage guidelines into practice: a simulation study using observations and interviews PONE-D-22-16565R1 Dear Dr. Abma, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Amjad Khan, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0286978.r003
Formally Accepted
15 Aug 2023 Acceptance Letter - Amjad Khan, Editor PONE-D-22-16565R1 Putting ICU triage guidelines into practice: a simulation study using observations and interviews Dear Dr. Abma: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Amjad Khan Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0286978.r004

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