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There is no one “hospital policy” pertaining to the process whereby hospital administrators determine which among multiple patients receive priority for treatment or for available space. Medical ethics direct that decisions pertaining to such matters be determined solely on the basis of need. Emergency room staff are trained in triage: the process of rapidly assessing the condition of multiple patients, determining which are most in need of immediate attention, and responding accordingly. When two or more patients are equally in need of care, however, deciding factors can veer well-off of the ethical highway into murkier and less ethical procedures. What are known as “ambulance diversions,” for example, involve the rejection of some patients due to overcrowding and the decision to send them to another facility for treatment. Unfortunately, such practices, which, by nature, generally involve densely populated urban areas, usually come at the expense of racial or ethnic minorities who are less likely to have health insurance. Some such diversions are justified on the basis of medical requirements such as the unavailability of a medical specialist at the initial facility or because a crisis has overburdened that facility. Many ambulance diversions, however, occur for economic reasons. Financial calculations, historically, have constituted the regrettable determinant in many decisions regarding availability and quality of medical care.
The scenario provided in the question – what is hospital policy for deciding which among two equally ill or injured patients receive the sole available bed – is a little more complex, as the equitable nature of the patients’ conditions may result in decisions predicated upon financial considerations. Most discussions of patient triage procedures involve the Emergency Room, as that is where many of the more complicated situations arise. This, however, is where the student question becomes vague. The specification of “room” could portend a deliberate distinction between routine admitting policies with regard to scheduled procedures and the aforementioned emergency situations. Nonemergency procedures can obviously be rescheduled; emergency procedures do not allow for such flexibility. A situation involving two patients both requiring an emergency appendectomy could result in the diversion of one patient to the closest alternative facility, and that decision could hinge on specifications in each patient’s insurance policies. For instance, do the primary care physicians enjoy privileges at the alternative facility? Is the alternative facility a “preferred” facility under the patient’s insurance policy, a decision that could involve thousands of dollars? Is the surgical procedure normally performed on an “outpatient” basis? There is not sufficient information in the student’s question to provide one single answer.
For purposes of discussion, if one assumes two patients with medical emergencies and only room for one, then the hospital’s policy will likely be to provide a bed for the patient with the requisite insurance coverage. Diverting the other patient to another facility, however, carries risk for the hospital, as failure to treat an emergency situation can leave the hospital vulnerable to civil liability. Just as likely, however, is that the hospital will make room for both patients. In the case of two equally ill or injured patients requiring immediate attention, triage procedures will trickle through the facility. As there is almost certainly at least one ER patient whose condition is stable and, possibly, not an emergency (abuse of emergency rooms for nonemergency conditions is a serious problem, although patients don’t always know whether their condition constitutes a medical emergency), it is probably at least one bed can be identified with a patient who no longer needs it. Not for nothing is it fairly common to see patients on gurneys in emergency rooms resting “comfortably” in ER hallways, quietly awaiting their turn for a cubicle or room. At the end of the day, however, the student’s question probably is intended to evoke an answer indicting the current system for the fact that “ability to pay” often, historically, has been the deciding factor in situations such as the one outlined in the question.
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