Triage at the NHLBI. Common sense.

W e would like to focus on peer review of grant applications at the National Heart, Lung, and Blood Institute (NHLBI), particularly on the use of triage to increase the efficiency of the review process. This topic initially received considerable attention at the National Institutes of Health (NIH) in the mid 1980s because of the need to expedite review of AIDSrelated research applications. An interim policy on triage was prepared by the NIH Review Policy Committee, establishing that triage decisions were to be made by peers, not by NIH staff. That policy forms the basis for the triage process recently put into use at the NHLBI. The institute's current approach reflects a pressing need to reduce the personnel and administrative costs associated with conducting special reviews. The NHLBI Review Branch provides initial scientific review for all grant applications and contract proposals received from requests for grant applications (RFAs) and requests for contract proposals (RFPs), program projects, institutional training grants, clinical trials, and other specialized programs totaling nearly $1 billion in requested funds annually. The process includes selecting peer reviewers, organizing review meetings, and preparing summary statements. The triage procedure we have begun to use for grant applications is currently directed almost entirely toward responses to RFAs, which constitute a significant portion of the review branch's workload. Between March 18 and August 2, 1993, the review branch directed a total of 30 review committee meetings for 15 RFAs with a total of 479 applications. The projected number of awards from the RFAs was 81 to 90, as specified in the solicitations. Given the fact that only 15% to 20% of the applications submitted for the RFAs could be funded, it seemed reasonable to focus efforts on a detailed examination of the subset of applications that had a realistic chance of success in each competition. Accordingly, the mailing of review materials to review committee members included special instructions with respect to assessing the relative competitiveness of applications. Reviewers were told that they would be expected to categorize each application assigned to them as clearly competitive, possibly competitive, probably not competitive, or clearly noncompetitive. They were asked to prepare a full critique of all assigned applications in the usual manner. At the meeting, each reviewer (primary, secondary, and reader plus anyone else familiar with the application) rendered an assessment of the level of competitiveness of each application. After the votes were tal-