Rationing in Health Care

Disaster Management Plan Emergency Needs Assessment Case Overview There are many tough decisions that hospital facilities have to make in the event of a disaster and preparation is one of the critical success factors in such a situation that can make a world of difference. For example, the delivery of critical care in the emergency department is critically important to identify the nature of critically injured patients and decide whom to attend to first and who needs medical attention at the earliest.

Furthermore, in the event of a category 3 hurricane, such as Hurricane Victoria, such a disaster can greatly exacerbate the limitations of a hospital to provide the needed neurological intensive care services. This analysis will provide an overview of the steps that can be taken in the event of a major public emergency and the role that needs assessment and service rationing play in such an event.

Case Study Analysis A disaster or emergency management plan begins with the goal of mitigating the emergency as much as possible regardless of the type of emergency that is present (Warfield, 2002). If an organization has conducted emergency management planning with a wide range of potential risks that they may face, then they have most likely made a list of the total possible types of emergencies that they may face. Using this list a response plan can begin to be created and stakeholders can begin to map vulnerabilities.

Mapping the various factors that are involved with any potential risk can provide a clear overview of the mitigation strategies needed (Michigan University, N.d.). There are also many critical success factors that are often important regardless of the actual type of emergency or disaster that occurs. For example, communication is among the highest critical success factors in the event of an emergency and there are some forms of communication are more effective than others in certain situations.

Furthermore, after a category 3 hurricane, it is extremely possible that many forms of communication that require extensive infrastructure could be disabled. For example, after the events of September 11th, 2001, one of the responder's biggest challenges involved communication and some teams actually had to send individuals to physically pass messages to other parties since much of the communication technologies had been knocked out and emergency communication procedures had yet to be developed.

One of the specific challenges that a neurological intensive care unit will face after a major natural disaster that injuries numerous individuals, will be to identify and to prioritize their patients' needs. A triage acuity level is a proxy measure of the possible and safe time period that an individual patient can safely wait for a medical screening examination and treatment (Gilboy, 2012). Obviously in such a situation, some patients will require immediate attention while others can more safely wait to receive care.

The rapid identification of patients that need immediate attention is one of the benefits of the emergency severity index and having such a model in place before an emergency occurs can be an invaluable asset to intensive unit serves. The emergency severity index uses a five level categorization process that is used to rapidly sort emergency patients into five groups that are based on clinically meaningful differences in projected resource needs available at the emergency department at that particular point in time.

Another critical issue will be the rationing of services and resources based on the needs identified. However, rationing is not only a concept that is related to an emergency situation. Recent studies into nursing care rationing indicate that nurses always ration their time and care, resulting to serious threats to the quality of care and patient safety; for example, patient mobilization, hygiene, feeding, communication, patient support, teaching and discharge planning, surveillance and care documentation are regularly lacking or omitted (Papastavrou, 2013).

Yet because rationing is often a sensitive issue in the American healthcare system, this issue is often neglected to be discussed and this practice occurs more implicitly; Implicit rationing of care is defined as the withholding of or failure to carry out all necessary nursing measures due to the lack of resources available (Papastavrou, 2013). However, in the event of an emergency, it is often necessary to effectively ration resources based on the needs assessments of patients and the traditional operational procedures may breakdown.

For example, in a crisis event, it may make sense for nurse to provide greater levels of care than they would under typical operations given the needs assessment in relation to the resources that are available. Some hospitals have actually created formal rationing procedures that are used in normal operations.