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With Experts Predicting a Second Wave of the Pandemic

How Hospitals Decide Patient Prioritization During a Crisis

By Caroline Campbell on Jun 25, 2020

Editor Note: Understanding the importance of this timely topic and to ensure that research is made available to the wider academic community, IGI Global has made a sample of related articles and chapters complimentary to access. View the end of this article to freely access this critical research.

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Although many countries are starting to reopen from the current pandemic, the cases are still continually increasing with nearly 2,300,000 cases in the United States alone. Through this pandemic, hospitals have been challenged with treating an increasing number of patients, working with limited medical supplies, and limited staffing. Based on these factors, a recent New York Times article shed light on how patients are prioritized during an emergency or where there are not enough resources to treat a large-scale outbreak.

Historically, around the world, hospitals would use age as a “cutoff or pre-existing conditions like advanced cancer, kidney failure or severe neurological impairment,” as they have a lower survival rate. However, with this recent pandemic, many researchers are re-evaluating the way hospitals decide what patients to treat, admit, or transport, as the past methods have been noted to be discriminatory. Some hospitals are still implementing “score cards” based on patients’ survival; however, researchers have proposed a lottery system or a “first-come-first-serve.” However, what if doctors are able to easily prioritize patients’ efficiently and effectively, while ensuring the patients’ safety? 

Dr. Samira Abbagholizadeh Rahimi, from Université Laval, Canada, outlines a proposed solution in her article, “Application of Fuzzy Soft Set in Patients' Prioritization,” from Research Anthology on Hospital Management and Emergency Medicine: Breakthroughs in Research and Practice (IGI Global). In the article, Dr. Rahimi proposes the use of fuzzy soft sets to prioritize patients through a novel hybrid framework. Through this framework, it will streamline inefficiencies in healthcare delivery, quality of care, and most importantly on patients' safety. View the article below:

Research Anthology on Hospital Management and Emergency Medicine: Breakthroughs in Research and Practice
Copyright 2020| Pages: 627 | ISBN: 9781799824510| EISBN:9781799824527

This publication examines the latest scholarly material on emerging strategies and methods for delivering optimal emergency medical care and examines the latest technologies and tools that support the development of efficient emergency departments and hospital staff...Learn More.

Prioritizing Patients’ Access to Healthcare Services

Patients in the Organization for Economic Co-operation and Development (OECD) countries (including United States and Canada) continue to wait too long to receive medically necessary treatment. Waiting times’ situation not only have not been improved during years till 2016, but also they have gotten slightly worse (Barua, 2015). One of the main reasons for long waiting times is imbalance between demand and availability of scarce resources in healthcare organizations. Clinicians can’t treat all patients simultaneously. Due to high costs, managers can’t increase number of their limited resources either. Then, patients’ access to these services should be prioritized in a way that best uses existence scarce resources, and insure patients' safety.

However, prioritization may not be the only option responding to limited resources in health care, but it may be one of the best options in identification of high risk patients and increasing safety of patients’ waiting for treatment. There are other alternative like increasing efficiency or the overall amount spent for health care, and rationing by delay. But, rationing implicitly goes along with problems in principle (Nagel & Lauerer, 2016), and is not sufficiently narrowing the gap that occurs between demand and supply (Williams et al., 2012). Rationing regularly refers to actual withholding of health services, while prioritization describes a systematic and comprehensive approach to analyze what is more and what is less important. It leads to a ranking order (Meyer & Raspe, 2012) and a precise selection of patients’ for treatment. Prioritization in healthcare domain is preferable approach over implicit approaches like rationing when tight budgets force clinicians to make allocation decisions (Nagel & Lauerer, 2016). Prioritization helps to allocate scare resources fairly and transparently (Nagel & Lauerer, 2016).

Currently, in healthcare systems after patients are referred to treatment, their situation is examined. If patients have non-life-threatening condition, they will be enrolled on a first-come, first serve basis (Abbasgholizadeh Rahimi et al., 2016). But if their conditions are life-threatening they will be registered two or three emergency groups/priority levels. Higher priority-patients will be selected for service prior to those with a lower priority, regardless of when they are placed on the list (Barua, 2015). In the literature review, the comprehensive explanation of the different developed/used prioritization tools will be explained in details.

Inappropriate prioritization of patients waiting for treatment, affect directly on inefficiencies in health care delivery, quality of care, and most importantly on patients’ medical conditions. Reports regarding the harms related to long waiting times and inappropriate prioritization of patients on waiting list are increasing. These harms include:

  • Poorer medical results from care and decreased quality of life,
  • Reduction in effectiveness of treatment (Day, 2013),
  • Increased pain, and risk of adverse events (Barua & Esmail, 2013),
  • Mortality (Prentice & Pizer, 2007), and so more.

An appropriate patients’ prioritization can play an important role in diminishing these undesirable outcomes. Besides, it can have significant impact on both medical community and public's faith in justice and equity.

An excellent prioritization in health system requires not only good recognition of the system, expertise to analyze and understand the information (related to patients, clinicians and other resources) but also to consider and organize that information regularly in a way to make an adequate decision and to promote a collaboration among key stakeholders (e.g. managers, clinicians, patients).

There are different major challenging aspects in prioritization of patients’ access to healthcare services as (Abbasgholizadeh Rahimi et al., 2016):

  • How to involve confronting trade-offs between multiple, often conflicting, factors?
  • How can groups of clinicians’ opinions be simultaneously involved in the decision-making procedure?
  • How can patients and their families be involved in the decisions?
  • What are the main criteria for prioritizing patients?
  • What are the risks that could threaten patients on waiting list?
  • How important are selected risks and criteria compared to each other?
  • How can we handle uncertainties in clinicians’ decisions in the procedure be handled?
  • How dynamic nature of the health system could be considered in prioritization of patients?

Currently, access to healthcare services are not prioritized in a way that best uses limited resources and to ensure a transparent, equal and accurate rank of patients on waiting lists. There is no reliable and comprehensive method of assessing the relative priority of patients on waiting lists, and some researchers (Peacock et al., 2009;Domènech et al., 2013;Abbasgholizadeh Rahimi et al., 2014, 2016; Mullen, 2003; Russell et al., 2003; Abbasgholizadeh Rahimi & Jamshidi, 2014; Comas et al., 2008) in their studies stressed the need for an interdisciplinary and collaborative research to explore systematic and precise prioritization framework. Although some prioritization approaches have been developed for this aim but, they have several major shortcomings (Abbasgholizadeh Rahimi et al., 2016). following, we will discuss on how patients are prioritized currently and what are their main shortcomings…

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Understanding that the latest research around hospital management and medicine is of the utmost importance, the latest research covering hospitalization, overcrowding, patient flow, and more is found in the Hospital Management and Emergency Medicine: Breakthroughs in Research and Practice (IGI Global). This title examines the latest scholarly material on emerging strategies and methods for delivering optimal emergency medical care and examines the latest technologies and tools that support the development of efficient emergency departments and hospital staff. While highlighting the challenges medical practitioners and healthcare professionals face when treating patients and striving to optimize their processes, the book shows how revolutionary technologies and methods are vastly improving how healthcare is implemented globally.

It is currently available in electronic format (EISBN: 9781799824527) through IGI Global’s Online Bookstore at a 50% discount, and is featured in IGI Global’s InfoSci®-Books database (5,900+ e-books). Recommend this publication and the InfoSci-Books database to your library to have access to this critical research, as well as thousands of other research resources, including the chapters below, in the IGI Global InfoSci-Books database.



Complimentary Research Articles and Chapters on Hospital Management, Healthcare, and Medical Technologies

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