NHS-FXP4000 | Applying Ethical Principals Topic:Case Analysis: Emergency Department Repeat Admissions

Summary of the Case Facts

Matt Losinski is the Chief Executive Officer of the County General Hospital. He is worried that the facility might be wasting its financial resources due to the overuse of the emergency department(ED) for minor, nonspecific medical issues. He decides to discuss the issue with Mary Scott, his Chief Financial Officer. However, Scott does not consider ED repeat admissions a matter of urgency because Medicaid pays for 75% of the expenses, and the remaining 25% are cross-subsidized from self-pay emergency admissions and privately insured individuals. Losinski gets bothered by the indifference reaction he receives from Scott. For this reason, he asks Aniysha Patel, the administrative resident, to furnish him with data regarding the use rates of individuals who were repeatedly admitted to the emergency department. The findings suggest that the issue is not as extreme as those from Central Texas hospital.

However, the results indicate that a few patients made hundreds of visits to the ED despite having minor, nonspecific medical problems. Losinski also found out that more than $200,000ED costs were not reimbursed to the facility annually. He felt that this money could be channeled towards promoting health initiatives for the community. Losinski also noted that repeated admissions to ED resulted in patients’ dissatisfaction, treatment delays, and crowding. He presented the findings to the executive committee, who were not interested in addressing the issue. Instead, they agreed that all patients meeting the active labor Act (EMTALA) and the federal emergency medical treatment requirements must be treated and stabilized. Losinski took upon himself to address ED overuse upon asking permission from the senior management.

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The Ethical Dilemma in the Case Study

The overuse of the emergency department for minor issues is a significant problem at the County General Hospital. However, the primary stakeholders are not concerned because the emergency services are catered for by Medicaid, self-pay emergency admissions, and privately insured individuals. The facility incurs $ 200,000emergency department costs that are not reimbursed to the facility every year. The Chief Executive Officer feels that this money could be channeled to promoting the health and well-being of the patients and the community by addressing the overuse of the emergency department services.  However, the Executive committee feels that the issue is not that important. Instead, they should continue providing emergency services for patients who meet the active labor Act (EMTALA) and the federal emergency medical treatment requirements.

Individuals Involved in the Ethical Dilemma

The primary stakeholders in the ethical dilemma include the Chief Executive Officer, The Chief Financial Officer, the Executive Committee comprising of the vice presidents, the director of development, and the elected president of the medical staff, and the senior management team. It is the role of these individuals to provide viable solutions to reducing the overuse of emergency departments for minor issues.

Analyzing the Case Using the Ethical Decision-Making Model

The ethical decision-making model is defined by three components, such as ethical behavior, moral judgment, and moral awareness. Moral awareness requires a person to note an ethical issue in a situation (Lincoln & Holmes, 2011). For instance, individuals must know when their actions or responses cause harm or are beneficial to the target audience. In the case study, it is evident that management failed to address the overuse of emergency department for minor issues, thus undermining patients satisfaction with the quality of services caused by overcrowding and treatment delays. Nonetheless, they are reluctant to address the issue, forcing the CEO to shoulder the burden of finding a viable solution.

 Moral Judgment entails the identification of possible solutions to the issues affecting patient satisfaction and misuse of resources. A sound decision should be made after analyzing the repercussions of every alternative solution provided (Lincoln & Holmes, 2011). In the case study, the Executive Committee should identify possible solutions to reducing the overuse of emergency department services for non-emergent challenges. The answers might range from offering units for non-urgent primary care, redesigning primary care to enhance scheduling and access, and the use of financial disincentives and incentives for emergency department visits. Lastly, ethical behavior encompasses an individual course of action given the issue being faced. For instance, it