Insurance-based inequities in emergency interhospital transfers: an argument for the prioritisation of patient care

2021 ◽  
pp. medethics-2020-107074
Author(s):  
Jacob Riegler
Keyword(s):  
Emergency Department ◽  
Ethical Issues ◽  
Financial Burden ◽  
Current Policy ◽  
Uninsured Patients ◽  
Hospital System ◽  
Patient Transfers ◽  
Transfer Rates ◽  
Emergency Situations ◽  
Profit Maximisation

Currently there is an inequity in transfer rates of uninsured patients versus their insured counterparts. While this may vary by hospital system, studies indicate that this is a national trend, especially in emergency situations, and represents a prioritisation of profits over ethical obligations. This creates a variety of ethical issues for patients and society that generates a concordance between deontological and utilitarian viewpoints, two generally opposed schools of thought. The prioritisation of profit maximisation in order to provide better care for a select population is insufficient to justify deleterious health outcomes, stress and financial burden on patients. Current policy regarding patient transfers in the emergency department is insufficient to protect the uninsured and must be reevaluated.

Responding to Social Responsibilities and Ethics - A Study of Refractory Industry in Odisha

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Saikat Gochhait
Keyword(s):  
Corporate Social Responsibility ◽  
Social Responsibility ◽  
Ethical Issues ◽  
Business Organizations ◽  
Ethical Practices ◽  
Secondary Sources ◽  
Modern Business ◽  
Industrial Markets ◽  
Corporate Social ◽  
Profit Maximisation

Businesses work in a wide social environment in which they have a responsibility to a range of stakeholders including the community. The term Corporate Social Responsibility (CSR) refers to the responsibility that modern business organizations have to creating a healthy and prosperous society. Ethical practices in refractory marketing help marketers distinguish between right and wrong behavior. Adherence to ethics is essential in industrial markets as mutual trust among buyers and sellers is the key to long-term success. Marketing has evolved from a production-centric approach to a societal marketing approach that lays greater emphasis on the ethical issues in marketing. With the advent of globalization, corporations continue to evolve, grow in power, and influence the process of consolidation. Corporations are in positions of power that allow them to do greater damage to others when they act unethically or socially in an irresponsible manner. The rights theory encompasses a variety of ethical philosophies holding that certain human rights are fundamental and must be respected by other humans. The economic theories of the firm cannot be segregated of ethical considerations as they have crucial impact on how the firm concentrates on economic power, formulate the rules of law. Profit maximisation has always been the driving force and an undercurrent behind the development of corporate. But profit is not made in vacuum, it always has an associated cost, some of which is always externalized (Rhee, 2008). Corporate law has an ethical foundation and the debate on values necessarily revolves round the activities of the firm. This research paper on the basis of secondary sources of data collected from reports, research papers and Internet, focuses on corporate social responsibility (CSR) of TATA Group with reference to Tata Krosaki Refractories Ltd, Bajoria Group with reference to IFGL Refractories Ltd (Odisha), OCL Refractories Ltd, Sarvesh Refractories, and Manishree Refractories (Odisha). The study intends to understand the scope of corporate social responsibility and get an insight in CSR and ethical practices in the light of the case study of the refractory industries in Odisha.

scholarly journals Exploring Factors Affecting the Emergency Specialists’ Decision-Making in Case of Emergencies in Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Abbasali Ebrahimian ◽  
Seyed-Hossein Hashemi-Amrei ◽  
Mohammadreza Monesan
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Qualitative Content Analysis ◽  
Decision Makers ◽  
Decision Making Process ◽  
Factors Affecting ◽  
Emergency Situations ◽  
The Core ◽  
Semistructured Interviews ◽  
Emergency Decision

Introduction. Appropriate decision-making is essential in emergency situations; however, little information is available on how emergency decision-makers decide on the emergency status of the patients shifted to the emergency department of the hospital. This study aimed at explaining the factors that influence the emergency specialists’ decision-making in case of emergency conditions in patients. Methods. This study was carried out with a qualitative content analysis approach. The participants were selected based on purposive sampling by the emergency specialists. The data were collected through semistructured interviews and were analyzed using the method proposed by Graneheim and Lundman. Results. The core theme of the study was “efforts to perceive the acute health threats of the patient.” This theme was derived from the main classes, including “the identification of the acute threats based on the patient’s condition” and “the identification of the acute threats based on peripheral conditions.” Conclusions. The conditions governing the decision-making process about patients in the emergency department differ from the conditions in other health-care departments at hospitals. Emergency specialists may have several approaches to decide about the patients’ emergency conditions. Therefore, notably, the emergency specialists’ working conditions and the others’ expectations from these specialists should be considered.

scholarly journals Interfacility transfers for US ischemic stroke and TIA, 2006–2014

Neurology ◽  
2018 ◽  
Vol 90 (18) ◽  
pp. e1561-e1569 ◽  
Author(s):  
Benjamin P. George ◽  
Sara J. Doyle ◽  
George P. Albert ◽  
Ania Busza ◽  
Robert G. Holloway ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Stroke Care ◽  
Hospital Level ◽  
Transfer Rates ◽  
The Us ◽  
Ed Visits ◽  
Low Volume

ObjectiveTo investigate changes in emergency department (ED) transfers for ischemic stroke (IS) and TIA.MethodsWe performed a retrospective observational study using the US Nationwide Emergency Department Sample to identify changes in interfacility ED transfers for IS and TIA from the perspective of the transferring ED (2006–2014). We calculated nationwide transfer rates and individual ED transfer rates for IS/TIA by diagnosis and hospital characteristics. Hospital-level fractional logistic regression examined changes in transfer rates over time.ResultsThe population-estimated number of transfers for IS/TIA increased from 22,576 patient visits in 2006 to 54,485 patient visits in 2014 (p trend < 0.001). The rate of IS/TIA transfer increased from 3.4 (95% confidence interval [CI] 3.0–3.8) in 2006 to 7.6 (95% CI 7.2–7.9) in 2014 per 100 ED visits. Among individual EDs, mean transfer rates for IS/TIA increased from 8.2 per 100 ED visits (median 2.0, interquartile range [IQR] 0–10.2) to 19.4 per 100 ED visits (median 8.1, IQR 1.1–33.3) (2006–2014) (p trend < 0.001). Transfers were more common among IS. Transfer rates were greatest among rural (adjusted odds ratio [AOR] 3.05, 95% CI 2.56–3.64) vs urban/teaching and low-volume EDs (AOR 7.49, 95% CI 6.58–8.53, 1st vs 4th quartile). The adjusted odds of transfer for IS/TIA increased threefold (2006–2014).ConclusionsInterfacility ED transfers for IS/TIA more than doubled from 2006 to 2014. Further work should determine the necessity of IS/TIA transfers and seek to optimize the US stroke care system.

scholarly journals Trends in outpatient emergency department visits during the COVID-19 pandemic at a large, urban, academic hospital system

2021 ◽  
Vol 40 ◽  
pp. 20-26
Author(s):  
Theodoros V. Giannouchos ◽  
Joseph Biskupiak ◽  
Michael J. Moss ◽  
Diana Brixner ◽  
Elena Andreyeva ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Visits ◽  
Academic Hospital ◽  
Hospital System

Participation of end users in the design of assistive technology for people with mild to severe cognitive problems; the European Rosetta project

2014 ◽  
Vol 26 (5) ◽  
pp. 769-779 ◽  
Author(s):  
F. J. M. Meiland ◽  
B. J. J. Hattink ◽  
T. Overmars-Marx ◽  
M. E. de Boer ◽  
A. Jedlitschka ◽  
...  
Keyword(s):  
Participatory Design ◽  
Ethical Issues ◽  
End Users ◽  
Community Dwelling ◽  
Modular System ◽  
Individual Interviews ◽  
Emergency Situations ◽  
People With Dementia ◽  
Expert Meeting ◽  
Informal Carers

ABSTRACTBackground:In the European Rosetta project three separate, previously developed, ICT systems were improved and integrated to create one modular system that helps community-dwelling people with mild cognitive impairment and dementia in different stages of the disease. The system aims to support them in daily functioning, monitor (deviations from) patterns in daily behaviour and to automatically detect emergency situations. The study aimed to inventory the end users’ needs and wishes regarding the development and design of the new integrated Rosetta system, and to describe the to be developed Rosetta system.Methods:Qualitative user-participatory design with in total 50 persons: 14 people with dementia, 13 informal carers, 6 professional carers, 9 dementia experts, 7 care partners within the project, and 1 volunteer. In the Netherlands user focus group sessions were performed and in Germany individual interviews. Dementia experts were consulted by means of a questionnaire, an expert meeting session, and interviews.Results:Persons with dementia and informal carers appreciated the following functionalities most: help in cases of emergencies, navigation support and the calendar function. Dementia experts rated various behaviours relevant to monitor in order to detect timely changes in functioning, e.g. eating, drinking, going to the toilet, taking medicine adequately, performance of activities and sleep patterns. No ethical issues regarding the use of sensors and cameras were mentioned.Conclusion:The user participatory design resulted in valuable input from persons with dementia, informal carers and professional carers/dementia experts, based on which a first prototype Rosetta system was built.

Impact of a nurse practitioner-staffed, symptom-management clinic on emergency department utilization in a large community oncology cancer institute.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 58-58 ◽  
Author(s):  
Shanthi Sivendran ◽  
Rachel Holliday ◽  
Kristen De la Torre ◽  
Kristina Braine Newport
Keyword(s):  
Emergency Department ◽  
Nurse Practitioner ◽  
Symptom Management ◽  
Financial Burden ◽  
Symptom Assessment ◽  
Median Number ◽  
Emergency Department Utilization ◽  
Large Community ◽  
Community Oncology ◽  
Oncology Practice

58 Background: Emergency department (ED) utilization among oncology patients is a source of patient distress as well as a financial burden to the health care system. Effective outpatient symptom management can potentially reduce ED utilization. In this analysis, we review ED utilization prior to and post the institution of a nurse practitioner staffed symptom management clinic in a large community oncology practice. Methods: In April 2014 a symptom management clinic staffed by a nurse practitioner five days a week was established at our outpatient cancer institute to increase patient access to acute symptom management. ED utilization 6 months prior to and post starting this clinic was measured. Only patients who received chemotherapy within 30 days of an ED visit were included in this analysis. Results: Between October 2013 and September 2014, a total of 420 visits to the ED were documented. A total of 196 visits occurred in the 6 months prior to establishing the clinic. There was an increase in visits to 224 after instituting the clinic. The median number of monthly visits was 34.5 (range 24-38) prior to the clinic and increased to 38 (range 30-43) after establishing the clinic. Conclusions: In our practice, a nurse practitioner led symptom management clinic did not reduce ED utilization in patients receiving chemotherapy. Based on published studies, other factors may need to be incorporated into our cancer institute to effectively reduce ED utilization. These include standardizing symptom assessment and management, patient and caregiver education on how to effectively manage symptoms at home, and improved coordination with supportive services.

scholarly journals Variation in Emergency Department Transfer Rates from Nursing Homes in Ontario, Canada

2016 ◽  
Vol 12 (2) ◽  
pp. 76-88
Author(s):  
Andrea Gruneir ◽  
Susan Bronskill ◽  
Alice Newman ◽  
Chaim Bell ◽  
Peter Gozdyra ◽  
...  
Keyword(s):  
Emergency Department ◽  
Nursing Homes ◽  
Transfer Rates
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