ETHICAL DECISION MAKING 2
Ethical Decision Making
Reduction of hospital readmission cases is the ethical dilemma in this case. An example of such a situation is seen where a 78-year old male was diagnosed with congestive heart failure and was admitted to a nursing facility following three days of acute care in the hospital. The patient has been hospitalized four times for the past eleven months (Evans, 2012). Every time he was discharged he went directly home from the hospital. After a few days in the nursing facility, the patient started experiencing shortness of breath, and he required supplemental oxygen. A physician examined him, and it found that he had diminished breath sounds in both of his sides but mostly on his right. He was sent to the hospital and he was subsequently readmitted to the same hospital. This situation alerted the hospital’s chief of staff who immediately summoned the nursing facility administrator to complain about the case. It was found that the facility’s nursing unit had the highest rate of readmission in the area than any other. The patient was seen to have a large right pleural effusion after proper diagnosis in the hospital.
Rehospitalization rates, especially for chronic conditions, have increased over the past few years especially for Medicare beneficiaries. Medicare has judged most of these cases to be avoidable since reports indicate that half the cases of readmission patients have not been seen by a physician or any other health professional after their initial discharge from the hospital. It is recognized that the ethics of business is the making of profits while that of a healthcare systems caring is the most important. As an executive of a healthcare facility, one would find him/herself in a dilemma to make profits for the hospital or deliver care to the patients who would sometimes lead to the facility into losses. The cost of health care in any country is extraordinary and as an executive officer planning and initiation of follow-up care for patients with chronic conditions would be costly. In this case, the hospital would have to initiate follow-up care for the patient after a day or two of his discharge which would comprise of a team consisting of a nurse, a physician, and nutritionist who will have to check on him and several other patients. The formation of a follow-up team to each of the patient’s home is the right way to go about this case but how about the extra charges. The medical benefits of patients with chronic conditions especially those at old age are limited to the hospital and not their homes.
Patients are merely just discharged from hospitals sometimes while they are still sick and are expected to recover from home especially for patients with chronic conditions fully. This compromises the ethics and standards of healthcare by allowing ill patients to go back home instead of working hard and improving care. This results in patients needing more attention outside the hospital. This has led to several hospitals creating a post-acute care unit comprising of skilled nursing facilities, rehabilitation units and home health care agencies whose primary goal is finishing the job that hospitals seem to have neglected and no longer doing with the costs being incurred by Medicare (Abdul-Aziz et al., 2017). Due to this vast costs and poor care planning for patients, inadequate follow-up, and poor decisions made in hospitals bout patients discharges Medicare aligned their incentives by rewarding facilities that recorded fewer readmission cases. However, this approach has not worked out since most hospitals blame nursing facilities when patients are brought back to the hospital like in this case.
Communication
Healthcare professionals tend blaming others for an adverse outcome is natural especially when the person feels that he/she did their best. However as long as care of a single illness is in question, communication, care planning, coordination, and follow-up care is most critical. The absence of integration and communication between the hospital and the nursing facility is the cause of the patient’s readmission. The hospital should have followed up called or demanded to see the patient’s nurses at the nursing facility asses the patient’s condition before handing him over. This is an essential step so as the hospital to clarify any other issues that the patient might have or the physician might have missed in his/her earlier diagnosis.
In attempts to reconcile self-interested business and the alternating care for patients that need to come first (Abdul-Aziz et al., 2017).The offering of incentives and disincentives is the correct way of approach, but it is insufficient in attempts of improving the quality of health care. Active involvement of patient’s families and the patients reporting on the quality of care offered in various facilities is another way of ensuring that patients are not discharged while they are still sick. The development of follow up care teams is also another solution to the hospital readmission problem. Also, ensuring that patients have adequate access to hospital care for residents at nursing homes and need hospital readmission.
In conclusion hospital readmission ethical readmission cases mostly affect the hospital administration and the insurance firms. Appropriate measures as the ones discussed above need to be put in place and ensure that quality health care is delivered to patients and hospital readmission rates are decreased.
Reference
Evans, J. (2012). Hospital Readmissions, Ethical Issues, Unintended Consequences. Caring for the Ages, 13(4), 22.
Abdul-Aziz, A. A., Hayward, R. A., Aaronson, K. D., & Hummel, S. L. (2017). Association between Medicare hospital readmission penalties and 30-day combined excess readmission and mortality. JAMA cardiology, 2(2), 200-203.