Patient’s Rights and Ethics in the USA: Professionalism in Patient Care

2021 ◽  
pp. 57-62
Author(s):  
Afolami (Fagorala) Omolayo
Keyword(s):  
Patient Care ◽  
Patient’S Rights ◽  
The Usa

scholarly journals Rapid implementation of Inpatient eConsult Programme addresses new challenges for patient care during COVID-19 pandemic

2021 ◽  
pp. bmjinnov-2020-000557
Author(s):  
Sharon Rikin ◽  
Eric J Epstein ◽  
Inessa Gendlina
Keyword(s):  
Palliative Care ◽  
Infectious Diseases ◽  
Patient Care ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Qualitative Feedback ◽  
The Usa ◽  
New Challenges ◽  
Science Framework ◽  
Context Specific

IntroductionAt the early epicentre of the COVID-19 crisis in the USA, our institution saw a surge in the demand for inpatient consultations for areas impacted by COVID-19 (eg, infectious diseases, nephrology, palliative care) and shortages in personal protective equipment (PPE). We aimed to provide timely specialist input for consult requests during the COVID-19 pandemic by implementing an Inpatient eConsult Programme.MethodsWe used the reach, effectiveness, adoption, implementation and maintenance implementation science framework and run chart analysis to evaluate the reach, adoption and maintenance of the Inpatient eConsult Programme compared with traditional in-person consults. We solicited qualitative feedback from frontline physicians and specialists for programme improvements.ResultsDuring the study period, there were 46 available in-person consult orders and 21 new eConsult orders. At the peak of utilisation, 42% of all consult requests were eConsults, and by the end of the study period, utilisation fell to 20%. Qualitative feedback revealed subspecialties best suited for eConsults (infectious diseases, nephrology, haematology, endocrinology) and influenced improvements to the ordering workflow, documentation, billing and education regarding use.DiscussionWhen offered inpatient eConsult requests as an alternative to in-person consults in the context of a surge in patients with COVID-19, frontline physicians used eConsult requests and decreased use of in-person consults. As the demand for consults decreased and PPE shortages were no longer a major concern, eConsult utilisation decreased, revealing a preference for in-person consultations when possible.ConclusionsLessons learnt can be used to develop and implement inpatient eConsults to meet context-specific challenges at other institutions.

scholarly journals White lie during patient care: A qualitative study of nurses’ perspectives

2020 ◽  
Author(s):  
Alireza Nikbakht nasrabadi ◽  
soodabeh joolaee ◽  
Elham Navab ◽  
Maryam esmaeilie ◽  
mahboobe shali
Keyword(s):  
Qualitative Study ◽  
Patient Care ◽  
Healthcare Providers ◽  
Cultural Knowledge ◽  
Hospital Nurses ◽  
Structured Interviews ◽  
Related Factors ◽  
Patient’S Rights ◽  
Wide Range ◽  
Data Saturation

Abstract Background: Keeping the patients well and fully informed about diagnosis, prognosis, and treatments is one of the patient’s rights in any healthcare system. Although all healthcare providers have the same viewpoint about rendering the truth in treatment process, sometimes the truth is not told to the patients; that is why the healthcare staff tell “white lie” instead. This study aimed to explore the nurses’ experience of white lies during patient care. Methods: This qualitative study was conducted from June to December 2018. Eighteen hospital nurses were recruited with maximum variation from ten state-run educational hospitals affiliated to Tehran University of Medical Sciences. Purposeful sampling was used and data were collected by semi-structured interviews that were continued until data saturation. Data were classified and analyzed by content analysis approach. Results: The data analysis in this study resulted in four main categories and eleven subcategories. The main categories included hope crisis, bad news, cultural diversity, and nurses’ limited professional competences. Conclusion: Results of the present study showed that, white lie told by nurses during patient care may be due to a wide range of patient, nurse and/or organizational related factors. Communication was the main factor that influenced information rendering. Nurses’ communication with patients should be based on mutual respect, trust and adequate cultural knowledge, and also nurses should provide precise information to patients, so that they can make accurate decisions regarding their health care.

Physician alert: the legal risks associated with ‘on-call’ duties in the USA

2018 ◽  
Vol 94 (1113) ◽  
pp. 411-414
Author(s):  
Zachary R Paterick ◽  
Nachiket J Patel ◽  
Timothy Edward Paterick
Keyword(s):  
Informed Consent ◽  
Medical Treatment ◽  
Patient Care ◽  
Patient Relationship ◽  
Risk Of Falling ◽  
Best Interest ◽  
Legal Risk ◽  
Legal Risks ◽  
The Usa ◽  
Legal Concepts

On-call physicians encounter a diverse aggregate of interfaces with sundry persons concerning patient care that may surface potential legal peril. The duties and obligations of an on-call physician, who must act as a fiduciary to all patients, create a myriad of circumstances where there is a risk of falling prey to legal ambiguities. The understanding of the doctor–patient relationship, the obligations of physicians under the Emergency Medical Treatment and Labor Act, the meaning of medical informed consent and the elements of negligence will help physicians avoid the legal risk associated with the various encounters of being on call. After introducing the legal concepts, we will explore the interactions that may put physicians at legal risk and outline how to mitigate that risk. Being on call is time consuming and arduous. While on call, physicians have a duty to act morally and ethically in the best interest of the patients.

Volunteering in the United States of America

2018 ◽  
Author(s):  
Greg Schneider
Keyword(s):  
United States ◽  
Palliative Care ◽  
Patient Care ◽  
United States Of America ◽  
The United States ◽  
Care Quality ◽  
Direct Patient Care ◽  
Hospice Movement ◽  
The Usa ◽  
Hospice And Palliative Care

Hospice and palliative care volunteering in the United States of America (USA) has changed dramatically since its inception in the late 1960s. Inspired by physician Dame Cicely Saunders, the modern hospice movement officially began in the USA in 1971 with Florence Wald founding the first hospice, Hospice, Inc., a non-profit in New Haven, Connecticut. Then in 1983, the US Congress established the Medicare Hospice Benefit, whose Conditions of Participation (CoPs) mandated that volunteers must provide administrative or direct patient care in an amount that, at a minimum, equals 5 per cent of the total patient care hours expended by all paid hospice employees and contract staff. Hence, every hospice programme must have a volunteer programme in order to receive reimbursement for services rendered. The primary forces currently shaping hospice and palliative care volunteering have been regulations, care quality, skill requirements, liability concerns, and changing business objectives in a highly competitive environment.

scholarly journals Quality assessment of weekend discharge: a systematic review and meta-analysis

2020 ◽  
Vol 32 (6) ◽  
pp. 347-355
Author(s):  
Chia-Yu Chiu ◽  
David Oria ◽  
Peter Yangga ◽  
Dasol Kang
Keyword(s):  
Patient Care ◽  
Meta Analysis ◽  
Emergency Department Visits ◽  
Weekend Effect ◽  
Cochrane Library ◽  
Quality Of Patient Care ◽  
Significant Difference ◽  
The Usa

Abstract Purpose Hospital bed utility and length of stay affect the healthcare budget and quality of patient care. Prior studies already show admission and operation on weekends have higher mortality rates compared with weekdays, which has been identified as the ‘weekend effect.’ However, discharges on weekends are also linked with quality of care, and have been evaluated in the recent decade with different dimensions. This meta-analysis aims to discuss weekend discharges associated with 30-day readmission, 30-day mortality, 30-day emergency department visits and 14-day follow-up visits compared with weekday discharges. Data sources PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched from January 2000 to November 2019. Study selection Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Only studies published in English were reviewed. The random-effects model was applied to assess the effects of heterogeneity among the selected studies. Data extraction Year of publication, country, sample size, number of weekday/weekend discharges, 30-day readmission, 30-day mortality, 30-day ED visits and 14-day appointment follow-up rate. Results of data synthesis There are 20 studies from seven countries, including 13 articles from America, in the present meta-analysis. There was no significant difference in odds ratio (OR) in 30-day readmission, 30-day mortality, 30-day ED visit, and 14-day follow-up between weekday and weekend. However, the OR for 30-day readmission was significantly higher among patients in the USA, including studies with high heterogeneity. Conclusion In the USA, the 30-day readmission rate was higher in patients who had been discharged on the weekend compared with the weekday. However, interpretation should be cautious because of data limitation and high heterogeneity. Further intervention should be conducted to eliminate any healthcare inequality within the healthcare system and to improve the quality of patient care.

scholarly journals Trauma center funding: time for an update

2021 ◽  
Vol 6 (1) ◽  
pp. e000596
Author(s):  
Heather M Grossman Verner ◽  
Brian A Figueroa ◽  
Marcos Salgado Crespo ◽  
Manuel Lorenzo ◽  
Joseph D Amos
Keyword(s):  
Patient Care ◽  
Trauma Care ◽  
Statistical Significance ◽  
Pairwise Comparison ◽  
Steady Increase ◽  
Trauma Centers ◽  
Level Of Evidence ◽  
Trauma Service ◽  
The Usa ◽  
Level I

BackgroundUncompensated care (UC) is healthcare provided with no payment from the patient or an insurance provider. UC directly contributes to escalating healthcare costs in the USA and potentially impacts patient care. In Texas, there has been a steady increase in the number of trauma centers and UC volumes without an increase in trauma funding of UC. The method of calculating UC trauma funds in Texas is imprecise as it is driven by Medicaid volumes and not actual trauma care costs.MethodsFive years of annual trauma UC disbursement reports from the Texas Department of State Health Services were used to determine changes in UC economic considerations for level I, II, and III trauma centers in the largest urban trauma service areas (TSAs). Data for UC costs, compensation, and TSA demographics were used to assess variations. Statistical significance was determined using a Kruskal-Wallis test with Dunn’s pairwise comparison post-hoc analysis and logistic regression.ResultsTSA-E (Dallas-Fort Worth area) has 33% of the level I trauma centers in Texas (n=6) and yet serves only 27% of the total state population across 14 metropolitan and 5 non-metropolitan counties. Since 2015, TSA-E has shown higher UC costs (p<0.02) and lower reimbursement (p<0.01) than the second largest urban hub, TSA-Q (Houston area). TSA-E level I trauma centers trended towards decreased UC reimbursements.DiscussionThe unregulated expansion of trauma centers in Texas has led to an unprecedented increase in hospitals participating in trauma care. The unbalanced allocation of UC funding could lead to further economic instability, compromise resource allocation, and negatively impact patient care in an already fragile healthcare environment.Level of evidenceLevel IV; Retrospective economic analysis and evaluation.

Physician unionisation in the USA: ethical and empirical considerations and the free-rider problem

2020 ◽  
pp. medethics-2020-106668
Author(s):  
Arjun S Byju ◽  
Kajsa Mayo
Keyword(s):  
Collective Action ◽  
Patient Care ◽  
Improve Patient Care ◽  
Free Rider ◽  
Non Union ◽  
Justice As Fairness ◽  
Free Rider Problem ◽  
The Usa ◽  
Ethical Criteria ◽  
Union Action

While American physicians have traditionally practised as non-unionised professionals, there has been increasing debate in recent years over whether physicians in training (known also as interns, residents or house staff) are justified in unionising and using collective action. This paper examines specific ethical criteria that would permit union action, including a desire to ameliorate patient care as well as the goal of improving the conditions of working physicians. We posit that traditional rebuttals to physician unionisation often lean on an infinite conception of a doctor’s energies and obligations, one that promotes burnout and serves to advance the financial motives of hospital management and administration. Furthermore, this paper explores the empirical justifications for collective action, which include substantial reductions in medical error. Finally, we address the free-rider problem posed by non-union physicians who might benefit from working improvements garnered through union action. We conclude that in order to maintain a notion of justice as fairness, resident physicians who benefit from union deliberations are impelled to acquire union membership or make a commensurate donation and that the healthcare organisations for which they work ought to share in the responsibility to improve patient care.

Johns Hopkins Hospital notables portrayed on philatelic material

2011 ◽  
Vol 19 (4) ◽  
pp. 161-167
Author(s):  
Federica Guaraldi ◽  
Davide Gori ◽  
Ralph Hruban ◽  
Patrizio Caturegli
Keyword(s):  
Patient Care ◽  
Nobel Prize ◽  
Johns Hopkins Hospital ◽  
Research And Teaching ◽  
Postage Stamps ◽  
The Usa ◽  
William Osler

The philatelic medium is an extensive repository of the portraits of doctors of many nations. Using an electronic matching system to identify links between the lists of alumni and faculties register of Johns Hopkins Hospital in Baltimore and that of three stamp catalogues, 14 notable persons have been identified in the philatelic record. The Johns Hopkins Hospital was established in Baltimore in 1889 and instituted the revolutionary concept of combining patient care with research and teaching. Its founder Johns Hopkins (1795–1873) and 13 among alumni and faculties have been portrayed on postage stamps and first day covers of USA, Canada, Antigua, Barbuda, Palau, Maldives, Canada and Sweden. Five of them – du Vigneaud (1901–78), Smith (b. 1931), Nathans (1928–99), Hubel (b. 1926) and Wiesel (b. 1924) – were awarded the Nobel Prize for Medicine or Physiology. By means of the philatelic medium, portraits of Hopkins scientists and doctors, including Sir William Osler (1849–1919) and Dr Virgina Apgar (1909–74), are distributed in their many tens of thousands on envelopes sent not only to recipients in the USA but to the wider world.

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