Discrimination in the Emergency Department
There is discrimination in the emergency department because of the need for health care workers to implement standards in determining the extent of condition of patients brought to the emergency department for treatment for purposes of prioritization.It is in the process of screening the emergency of patients brought or seeking treatment in the department that discrimination occurs, through the ineffective or limited application of objectives and professional standards during the screening, flawed or baseless screening results, and weak prioritization decisions.
Discrimination in the emergency department could occur on the part of individual health care workers or due to the policies implemented by the emergency department.As such, the solution could require institution-wide effort in ensuring the implementation of sound policies for the emergency department together with an anti-discrimination culture encompassing the professional practice and actions of individual emergency health care workers.
An emergency pertains to the any critical situation or life-threatening condition.
Since the definition is broad, it allows health care workers in the emergency department room to exercise judgment in deciding what scenarios comprise an emergency. Common criteria applied in determining an emergency include unconscious patients rushed to the hospital, potential stroke victims, patients identified to have suffered serious blood loss, or patients with broken bones especially if this involves the spinal column. (National Health Service, 2007)
When the emergency department faces one or more of these criteria, together with other similar intervening factors, especially when many cases are received, the people in charge of the emergency department have to make decisions on a number of issues. The wide-range of allowance for personal judgment of health care professionals in the emergency department (Aberegg, Arkes & Terry, 2006) together with the need to make decisions with limited time requiring screening skills and experience as well as the implementation of objective professional standards (Gulland, 2003) opens room for biases and subjectivity.
First decision is on whether the cases taken singly comprise an emergency (Aberegg, Arkes & Terry, 2006). If so, then the case is considered for emergency action. If not, then the case is referred to the appropriate department. However, the determination of whether the cases constitutes an emergency should be made using professional standards to prevent the intervention of discriminatory practices such as considering a case as an emergency not because it constitutes a life threatening situations but because of biases against one case relative to the other cases (Gulland, 2003).
Second decision is the prioritization of all the cases determined as emergencies, brought to the emergency department at one time or in a given period (Aberegg, Arkes & Terry, 2006). The emergency department operates 24/7 so that personnel work on a shift basis resulting to a minimum number of personnel on standby at one time.
The number of personnel on standby depends on the trends in emergency cases based on the experience of the hospital and expected periods of the occurrence of emergencies such as forest fires and heat waves during the summer. With limited personnel, mounting cases can make prioritization difficult especially when cases are comparable in terms of the extent of seriousness of the health care need (Gulland, 2003). In these situations, prioritization is a necessity but decisions have requires justification.
During decision-making, discrimination could occur such as when white patients are prioritized over a black patient regardless of the extent of the life-threatening condition or younger patients are prioritized over geriatric patients even if the older patients require more immediate treatment and the availability of health care professionals in the emergency department allows the prioritization of the geriatric patient.
Third related decision is the action to be taken on the case, such as immediate treatment of the patient, referral of the patient to the health care personnel suited in handling the particular case, denial of treatment for certain reasons, referral of the patient for transfer to another health care facility, and other case-based actions (Aberegg, Arkes & Terry, 2006). Even if prioritization decisions are justifiable, action or implementation relating to the decision could involve discrimination such as when better service is extended to specific patients relative to other patients involved in comparable emergencies.
Overall, discrimination in the emergency department could include biases based on race or ethnicity, gender, age, economic status, or other views expressed in the three areas of decision-making previously discussed. This means that discrimination in the emergency department is multi-faceted. In addition, the degree of intervention of discrimination varies. The intervention of discrimination in the emergency department, from the perspective of emergency health care workers, could include either or both personal and professional bias.
Personal bias refers to subjective opinion of a person as against the patient or the circumstances of the case that could affect screening and intervention judgments. Professional bias pertains to the views of the health care workers regarding the condition of the patient, the emergencies, the intervention, and the role they play in this specific situation based on the knowledge and experience of the professional. Both could overlap and operate in creating discrimination in the emergency department. (Gulland, 2003; Aberegg, Arkes & Terry, 2006)
Based on the manifestations and causes of discrimination in the emergency department, a number of solutions become apparent. One is the efficient organization of the emergency department in anticipation of life threatening cases at any time. (Gulland, 2003) Since the number of available staff and the level of preparedness of the emergency department determines the creation of opportunities for discrimination since only a small number of emergency cases brought to the emergency department can be addressed.
Another solution is the development and continuous enhancement of the operational infrastructures of the emergency department including policies and guidelines in compliance with legal and professional standards, flexible budget and personnel allocation to the department, sound human resource management strategies, organizational culture grounded on objectivity, and other necessities in supporting the high level of preparedness and efficiency of the emergency department (“Interpretive Guidelines,” 2005).
This solution also works in limiting the opportunities for discriminatory action in the emergency department. Still another solution is the application of training and development programs in compliance with the principle of continuous learning. This means that health care workers assigned to the emergency department undergo continuous learning programs to update their knowledge and skills to be able to accommodate developments in professional practice as well as emerging issues arising in professional practice in the emergency department.(Gulland, 2003)
When this happens, the likelihood of discrimination lessens because updated information supports the achievement of more objective professional judgments or decisions on issues and challenges faced by the emergency department. Although the emergency department involves a wide-room for judgment and decision-making on the part of health care workers in the emergency department as well as poor support infrastructural support and organizing inefficiencies, which create situations that give rise to discrimination, the causes of discrimination in the emergency department are preventable by addressing these causes.