Paper Example on Triage Officers' Ethical Obligations for Efficient Patient Sorting

Introduction

Triage departments are characterized by a sense of urgency, and the need to efficiently allocate limited resources to a large number of patients through a critical decision-making process (Wagner& Dahnke, 2015). Therefore, triage officers are obligated to adhere to certain ethical dimensions that constitute the moral framework within which they make their decisions (Bambi et al., 2016). Triage officers have ethical obligations to sort patients as efficiently and quickly as possible, to avoid harming the patients, to take the patient's complains seriously, and to manage the patient's problems as per the predefined standards of care (Miake et al., 2017). Even so, the preservation of human life through prudent assignment of life-sustaining treatment to the critical patients is at the fore of triage objectives.

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Case 1

The first patient was appropriately triaged as green because she had no physical injuries, was not hemorrhaging, and was very alert. According to the triage system guidelines, she was not in danger and could be seen by the doctor with two hours. Also, there was sufficient care in assessing the status of the fetus, which was an essential prerequisite to determining the severity of the patient's injuries. The triage assessment was appropriate because the key discriminators that guide the allocation of patients into the clinical priorities, the conscious level, the pain, hemorrhage, life threat acuteness, and temperature, were complied with (Miake et al., 2017). The ethical guidelines such as respect for patient's autonomy, nonmaleficence, beneficence, and justice were also complied with. Combined, the efficiency in triaging the patient and the compliance with ethical considerations yielded positive outcomes for the patient.

Case 2

The second patient was appropriately triaged as red and was to be seen by the doctor within a minute because her vital signs were poor. However, the medical team, upon the realization that the patient was the perpetrator, abandoned her to attend to other patients, which led to a fatality. The emergency team's conduct has its underpinnings in the principle of utility. This principle upholds that actions should be considered based on the utmost net benefit among all the affected. Utilitarianism upholds that in such circumstances, the team ought to uphold the greatest good for the majority, especially in light of insufficient resources (Aacharya, Gastmans & Denier, 2011). Therefore, the quick decision to abscond the patient was appropriate, since it entailed giving priority to the victims of the shooting attack. However, the medical team's decision contravened the ethical consideration of nonmaleficence, which holds that they should do no harm to a patient but offer reasonably best care to the patient (Aacharya, Gastmans & Denier, 2011). Overall, the team's personal judgment and beliefs that the perpetrator's life was not a priority yielded a negative outcome for the patient because she lost her life.

Case 3

The third patient was suitably triaged as red, owing to her poor vital signs and the severity of her injuries, which had led to excessive hemorrhage. She was swiftly and aggressively treated, which was appropriate. According to The Manchester Triage Score, a patient who is triaged red should be seen by the emergency doctor immediately (Aacharya, Gastmans & Denier, 2011). The scale selects patients based on the highest priority and without making assumptions regarding diagnosis (Miake et al., 2017). Therefore, the prioritization was appropriate, and the triage session duration was short as per the requirement that the encounter between the patient and triage officer should not last more than four minutes (Aacharya, Gastmans & Denier, 2011). Overall, the patient outcome was positive, which can be attributed to the swift examination, appropriate prioritization, and adherence to ethical guidelines.

Case 4

The fourth patient was triaged green because she had no physical injuries, was not hemorrhaging, and was not in pain. The assessment was consistent with the to The Manchester Triage Score guidelines, which stipulate that a patient who has no life-threatening injuries is triaged green and does not need to be prioritized for emergency care ((Srinivasan et al., 2018). In addition, the triage officer was able to get his history about the post-stress traumatic disorder (PSTD), which informed the decision to keep him under observation for several hours before he could be discharged. Thus, the triage officer was effective and prudent to take the patient's history, and this ensured that he got the best reasonable care, notwithstanding that he had no visible injuries.

Case 5

The fifth patient was correctly triaged as red. The rationale applied was that his vital signs were poor based on the assessment by the triage officer. He was put on aggressive treatment, but he did not survive. Even so, it is apparent that the right procedures and ethical considerations were applied, particularly because the patient was a minor. In this case, the principle of justice was upheld. According to Miake et al., this principle holds that the worse-off patients should be prioritized because they are vulnerable (Ebrahimi et al., 2016). The subject patient was, thus, prioritized because he was severely injured and had a high risk of death. For those reasons, the patient was triaged red and accorded immediate and aggressive treatment. Notably, however, the triage officer did not take the patient's history from the mother, which was a lapse. There is a possibility that the patient had a preexisting condition, and the emergency team could have applied that knowledge to yield a different outcome.

Case 6

The sixth patient was triaged properly as yellow. She had a leg fracture and was swiftly stabilized and separated from her child. Moreover, she was not informed of the death of child until she was stable. First, the triage officer aptly took note of the visible injuries and general appearance of the patient when making the decision on how to triage her. Second, the triage nurse observed autonomy through prudent communication throughout the triage process. She did not reveal the condition of the child to the mother because the mother would have become emotionally distressed, and this would have impaired her treatment and stabilization. As well, the triage officer upheld nonmaleficence by reducing the patient's pain, averting emotional suffering by separating the mother and the child, and by averting any psychological harm that the mother would have gone through, had she seen her child's dire condition.

Case 7

The seventh patient was erroneously triaged green, and not red. Whereas the patient had no visible injuries and had an apparent language barrier, the triage officer failed to seek the use an interpreter. Also, when the patient indicated physical pain in his head, the emergency team took note of a laceration to the forehead and did not bother to carry out further comprehensive tests. As a consequence, the patient was misdiagnosed, and by the time they realized he had a subdural hematoma, it was too late, and he was already unresponsive and in a vegetative state. Hence, there were several lapses in the triage procedures.

For the seventh patient, the triage officer did not carry out an effective assessment of the patient, thereby erroneously triaging him as green instead of red. It is not clear which rationale the officer used because, at that point, the patient was still conscious and indicating the pain in his head. The second lapse was that the emergency team treated a wound instead of carrying out a CT scan at the onset. Thus, they made a costly assumption, and the severity of the patient's condition was realized after a lot of time had passed, and when he had become unconscious. Another lapse was that the triage officer did not make any effort to look for a Spanish interpreter; hence, she lost the opportunity to get critical details when the patient was still conscious. In this case, therefore, the treatment was futile because the triage officer did not comply with triage guidelines. The patient's outcome was adverse, and this would have been avoided had the triaging been carried out more effectively.

Conclusion

Overall, the seven patients present the triage department with key and practical lessons on triage management. The severity of failing to comply with triage guidelines is brought to the fore by the seventh patient because the outcome could have been different had the triage officer prioritized him and followed the standard operating procedures. However, in the first six patients, the triage officer upheld the relevant ethical considerations, triage management principles, and guidelines to ensure that the patients got the best reasonable care.

References

Aacharya, R. P., Gastmans, C., & Denier, Y. (2011). Emergency department triage: an ethical analysis. BMC Emergency Medicine, 11(1).doi:10.1186/1471-227x-11-16

Bambi, S., Ruggeri, M., Sansolino, S., Gabellieri, M., Tellini, S., Giusti, M., ...&Gravili, R. C. (2016). Emergency department triage performance timing. A regional multicenter descriptive study in Italy.International emergency nursing, 29, 32-37.

Ebrahimi, M., Mirhaghi, A., Mazlom, R., Heydari, A., Nassehi, A., &Jafari, M. (2016). The role descriptions of triage nurse in emergency department: a Delphi study. Scientifica, 2016.

Miake-Lye, I. M., O'Neill, S. M., Childers, C. P., Gibbons, M. M., Mak, S., Shanman, R., ...&Shekelle, P. G. (2017). Effectiveness of interventions to improve emergency department efficiency: an evidence map.

Srinivasan, D., Sreeramulu, P. N., Dave, P., &Sathanantham, D. K. (2018).Legal and ethical dilemma in treating trauma patients.International Surgery Journal, 5(9), 3146-3149.

Wagner, J. M., & Dahnke, M. D. (2015). Nursing ethics and disaster triage: applying utilitarian ethical theory. Journal of Emergency Nursing, 41(4), 300-306.