ETHICAL DECISION MAKING IN ACTION: EVALUATING HOSPITAL CARE ATTENDANCE APPROACHES

Abstract

Patient safety is a priority in the hospital. Hospitals are always considering cost effective ways to keep patients safe and free from harm. Every year an average of 340,000 hospitalized patients are injured due to falls. Providing the best possible care attendance to prevent these incidents is very important. It is demonstrated here that, beyond medical and financial considerations, the proper selection of care attendance is an ethical decision. This decision requires considering the needs of, as well as getting input from, all the parties involved (hospitals, nurses, and patients). Unfortunately, until now, the care attendance discussion has mainly considered the hospital’s perspective and rarely that of the patient. Using a stakeholder theoretical approach taken from ethical decision making literature and the Analytic Hierarchy Process which allows the integration of multiple stakeholder perspectives and the inclusion of intangible variables (such as patient’s perceived value), we developed an evaluation framework to enable the prioritization and allocation of resources to the different care attendance approaches: care attendant (CA), continuous video monitoring (CVM), normal rounding (NR) and family visitor sitters (FVS). The decision criteria have been identified from the extant medical evidence-based literature, and expert opinions from three decision-makers (each representing a particular stakeholder’s perspective) were used to assess the criteria weights and rate the alternatives.