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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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Emergency care, triage, and fairness.

Sigurd Lauridsen1

  • 1National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.

Bioethics
|November 14, 2019
PubMed
Summary

Emergency department triage prioritizes acute patients but struggles with sub-acute cases. A new "real dialogue model" with enhanced professional autonomy is proposed for fairer prioritization among the largest patient group.

Keywords:
accountability for reasonablenessemergency departmentspatient involvementpriority-settingsub-acute patients

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Area of Science:

  • Healthcare Management
  • Medical Ethics
  • Emergency Medicine

Background:

  • Triage is a critical process in emergency departments (EDs) for resource allocation.
  • Current triage systems prioritize patients based on the acuity of their condition to match demand with supply.
  • The principle of preserving core capabilities guides prioritization, effectively distinguishing between acute and sub-acute patients.

Purpose of the Study:

  • To identify limitations in current emergency department triage practices.
  • To propose a supplementary framework for prioritizing sub-acute patients.
  • To enhance the fairness and efficiency of patient prioritization in EDs.

Main Methods:

  • Critique of the existing triage principle based on preserving core capabilities.
  • Introduction of the "real dialogue model" as a supplementary framework.
  • Advocacy for enhanced professional autonomy for clinical decision-makers.

Main Results:

  • Current triage effectively prioritizes acute over sub-acute patients.
  • The existing model is insufficient for fair prioritization among sub-acute patients, who represent the majority.
  • The proposed "real dialogue model" offers a solution for equitable resource distribution within this patient group.

Conclusions:

  • The current triage system requires supplementation to address the needs of sub-acute patients.
  • The "real dialogue model," coupled with increased professional autonomy, can improve prioritization among sub-acute patients.
  • Fairer prioritization of all patient groups in emergency settings is achievable through model enhancement.