Marguerite M., an 89-year-old widow, is admitted into the cardiac intensive care
ID: 174379 • Letter: M
Question
Marguerite M., an 89-year-old widow, is admitted into the cardiac intensive care unit in Chicago’s Memorial Hospital at 3:00 A.M. on a Sunday morning with a massive heart attack (myocardial infarction). Her internist, c who is also a close family friend, has ordered an angiogram to determine the status of Marguerite’s infarction (heart attack). Dr. K. knows that the angiogram and resulting treatment need to be done within the first six hours after an infarction in order to be effective. Therefore, the procedure is going to be done as soon as the on-call surgical team can set up the angiography room. The radiologist, who lives thirty minutes from the hospital, must also be in the hospital before the procedure can begin. At 4:30 A.M. the team is ready to have Marguerite, who is barely conscious, transferred from the intensive care unit (ICU) to the surgical suite. Coincidentally, at 4:30 A.M. Sarah W., an unconscious 45-year-old woman, is brought in by ambulance with a massive heart attack. The emergency room (ER) physicians, after conferring with her physician by phone, conclude that she will need a balloon angiography (dilating an obstructed blood vessel by threading a balloon-tipped catheter into the vessel) to save her life. When they call the surgical department to have the on-call angiography team brought in, they are told that the room is already set up for Dr. K.’s patient. They do not have another team or surgical room for Sarah. A decision is made that because Sarah needs the balloon angiography in order to survive, they will use the angiography team for her. Dr. K. is called at home and told that his patient, Marguerite, will not be able to have the angiogram. The hospital is going to use the angiography team for Sarah, because she is younger than Marguerite and has a greater chance for recovery. Unfortunately, it took longer than expected to stabilize Sarah before and after the procedure and the six-hour “window” when the procedure could be performed on Marguerite passed. Marguerite expired
How do you think the hospitals’ “allocation of resources” effects this case scenario and the patients’ and care team?.
How do you think the hospitals’ “allocation of resources” effects this case scenario and the patients’ and care team.
Explanation / Answer
When resources are constrained and demand exceeds supply, allocation becomes a hassle. The degree of problem solving largely depends on the availability and nature of resources themselves. These considerations follow to healthcare as a great deal as they do to whatever else. Healthcare sources, whether understood in materialistically or in human terms, are confined, neither it is a characteristic of the way healthcare is given. The truth of hindrance is inherent inside the human situation. The amount of resources will constantly be limited as there is always a higher extent to the number of facilities that can be built, the number of instruments that can be produced, or the number of organs, amount of blood, etc that will be available. Thus demand for healthcare resources will always and necessarily exceed supply. That means that limitation is not an artifact which everytime leads to an allocation problem.
The usual approaches to the allocation problem are based on a selective method to what certainly is going on in healthcare with the appropriate resource allocation, and that the reason the hassle has proved so intractable is exactly as it has been approached in this limited fashion. Concentrating particularly on the material resources as done traditionally is definitely a part of the problem. It ignores the fact that it is far from the views of healthcare professionals – which is to say, the human resources change the merely material things into healthcare resources. Furthermore, from a technical perspective, it's far the healthcare professionals who feature as gatekeepers to the material resources which are in brief supply. They're, so to talk, the choke factor inside the get entry to and distribution structures.
In this case the resources had been wisely allocated with the idea of saving the younger patient Sarah, who also has a greater chances of recovery as compared to Marguerite.