Emergency department triage: an ethical analysis

Abstract

BackgroundEmergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency.DiscussionIn emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights.SummaryWe integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach.

Top ten caring needs of emergency department patients in Banyumas, Central Java province, Indonesia: patient's needs and cultural approach

“…20,21 Prompt care in emergency department needs to take ethical aspects into account, such as respect for patient's autonomy, justice, beneficence and non-maleficence. 22 All emergency department patients have to be treated equally, although the chosen procedure and facility utilisation are in accordance to each patient's unique condition. Patients expect that all of provided caresare truly safe.…”

Nursing Ethics at Emergency Department

“…(19) Acil bakımda zamanın dar olması, hastaların durumlarının acil olması, hastalardan çok az bilgi alınabilmesi, güvenlik güçleri ve diğer sağlık personeli ile birlikte çalışma zorunluluğu olması ve acil servisteki olanaklar gibi birçok faktörün birlikteliği hemşirenin görev ve sorumluluklarını karmaşık duruma getirmekte ve birçok etik sorunlarla karşılaşmalarına neden olmaktadır. (20) Acil servislere başvuran hasta sayısının artmasıyla birlikte, acil olanaklarının bu yoğunluğu karşılama düzeyi, (21) adil bir triyaj uygulaması, hasta yakınları ile iç içe çalışma durumu, (22,23) acil servis ortamında hasta mahremiyetinin sağlanmaya çalışılması, (24)(25)(26) acil hastanın bilgilendirilmesi ve onam alma (27) gibi faktörler etik karar verme sürecine etki edebilecek durumları ortaya çıkartmaktadır.…”

“…(34,36) Bu açıdan bakıldığında triyaj aslında kaynakların adil bir şekilde dağıtılması işlemidir. (23) Literatürde üçlü, beşli sını ama gibi çeşitleri olan bu sistemin temeli yaşam tehdidi olan hastaların belirlenip gerekli acil girişimlerin zaman kaybedilmeden yapılabilmesidir. (37,38) "Acil Servis Uygulama Usul ve Esasları Tebliği"ne göre triyaj, hekim, acil tıp teknisyeni, hemşire, sağlık memuru (toplum sağlığı) ve benzer nitelikteki sağlık personeli tarafından uygulanır.…”

A model of complaint based for overcrowding emergency eepartment: Five-Level Hacettepe Emergency Triage System

“…[1][2][3][4][5][6][7][8][9][10][11][12] Five-level triage systems have been commonly used in emergency departments of countries where emergency medical services have been developed. [23][24][25][26][27][28] In the United States, ESI has emerged as a new triage system in which education and experience are needed; it is the most widely used and is the most valuable of emergency triage systems.…”

“…[1][2][3][4][5][6][7][8][9] Inappropriate care areas and long durations for care in overcrowded emergency departments cause problems between patients and health care providers. [10][11][12][13][14] Different triage systems (2-Level, 3-Level, 4-Level and 5-Level) have been applied to determine the priority and management of health care for emergent patients in emergency departments. [15][16][17][18][19] A survey carried out in US in 4897 hospitals showed that there is no triage system in 0.7% of emergency departments, a 2-level triage system in 0.3%, a 3-level triage system in 25.2%, a 4-level triage system in 9.6%, a 5-level ESI triage system in 56.9%, another 5-level triage system in 6.3%, and other triage system in 0.1% of emergency departments.…”