Leaders working in case management are under unforgiving time limits, pressures, and resource constraints that make decision-making difficult. The challenge relates to the way healthcare is moving and the speed with which change is occurring within organizations as they continue to change, form partnerships, and other issues.
Most patients learn about the the option of left ventricular assist devices when they are facing the possibility of death. Emotion is high, and biases of cognition are prevalent. These issues pose challenges to ethical decision-making and informed consent.
Ethicists are seeing increasing numbers of consults involving extracorporeal membrane oxygenation (ECMO), the most aggressive life-sustaining technology available. With ECMO, which is currently offered by about 250 U.S. hospitals, some patients are saved who would otherwise die.
Federal law requires hospitals to inform patients of the need to choose a surrogate. However, many institutions perform this task poorly, due in part to a lack of clear policies, proper training, and other support. There are a few ways the ethics team can help.
A patient’s capacity to give informed consent or to leave the emergency department against medical advice is a topic of great relevance to emergency clinicians. This article discusses the difference between competence and capacity and highlights the four essential elements involved in the assessment of a patient’s capacity.
A multicenter, one-day prevalence, prospective, observational, double-blind study in 19 ICUs revealed that the decisionmaking capacity of ICU patients was widely overestimated by all clinicians as compared with a capacity score measured by the Mini-Mental Status Examination and the Aid to Capacity Evaluation.
In an observational study conducted at an academic medical center in London, researchers looked at factors involved in decision-making. The presumptive diagnosis of infection by the emergency department (ED) influenced decision-making by both medical and surgical admitting teams. Medical teams tended to use a multidisciplinary approach to antibiotic decision-making. Surgical teams often delegated antibiotic decision-making to the most junior members of the surgical team.