Decision-making Research Articles

Islamic Leadership Management in Pesantren

Many concepts of management and leadership have changed. In the Islamic concept, leadership is a concept of interaction, relationship, authority process, influencing, directing and coordinating activities both horizontally and vertically. Then, in management theories, the leader's function is as a planner and decision maker (planning and decision maker), organization (organization). Leadership and motivation (leading and motivation), supervision (controlling) and others. In any view, everything must be done neatly, correctly, orderly, and regularly. The processes must be followed properly. This research aims to examine more deeply the practices of Islamic leadership management in Islamic boarding schools. This study has at least two objectives: (1) mapping studies related to Islamic leadership management in general; (2) elaborating on the Islamic leadership concept at Pesantren. The results showed that the leadership style adopted by the Kiai greatly influences the educational environment, both in terms of academics and morals of the students. Therefore, the relationship between Islamic leadership and the success of Islamic boarding school management is very important, because it directly influences educational outcomes, organizational culture, and the overall effectiveness of these institutions.

Spatial Coupling Relationship Between Water Area and Water Level of Dongting Lake Based on Multiple Temporal Remote Sensing Images Data at Its Several Hydrological Stations

It is very well-known that the reliable coupling relationship between water area and water level is very important in analyzing the risks of floods and droughts for big lakes, such as Dongting Lake, especially when remote sensing images are absent and in situ measurements cannot be carried out. To obtain this relationship, two types of mathematical models—polynomial regression (PR) based on the least square algorithm and machine learning regression (MLR) based on the BP (Backpropagation) neural network algorithm—are constructed using the water area data extracted from multiple temporal remote sensing images and water levels recorded at several representative hydrological stations for nearly 30 years. In this study, Dongting Lake is divided into three parts: East Dongting Lake (EDL), South Dongting Lake (SDL), and West Dongting Lake (WDL). This is because water slope exists on its surface, which is formed by several inflow rivers and the high and low terrain. To calculate the total water area of this lake, two ways are put forward by choosing the water levels: from EDL, SDL, and WDL in their turn; or from all three simultaneously. In other words, three univariate and one multivariate regression. For PR, there are perfect coefficients of determination (most nearly 0.95, the smallest being 0.76), which is in line with regression test relative errors (between 0.27% and 6.7%). For MLR, which was initially applied to this problem, the best node number (10 for the first way, 8 for the second way) in the hidden layer of the neural network is adaptively chosen, with coefficients of determination (similar to PR), together with training and testing error performances (between 1% and 10%). These results confirm the validity and reliability of them. The regression and prediction results on the two models are better than the documented way (only focus on the water level of EDL). These results can provide some references for researchers and decision makers in studying similar big Lakes.

Sustainability Assessment of Employing Chemical Recycling Technologies on Multilayer Packaging Waste

While multilayer plastic is difficult for recycling, innovative technologies and tactics are being developed to improve the process. New technologies in chemical recycling show promising results; however, the net improvement brought to the environment, economy, and society should be assessed for their wider adoption and diffusion. This study focuses on a Life Cycle Sustainability Assessment (LCSA) of an innovative process for the sorting and chemical recycling of multilayer plastic packaging waste from post-consumer sources to obtain new packaging for the food industry. The analysis indicated that the packaging made of rPET obtained through depolymerization is environmentally and economically competitive compared to the virgin PET. Packaging made of rPET and rLDPE obtained through delamination usually performed worse (or comparable) than the virgin counterparts. The social impact assessment indicated some areas of concern (e.g., workers’ health and safety risks due to exposure to hazardous substances), as well as potential opportunities (e.g., improved local employment). This paper is the first to present a synergetic approach to the sustainability assessment of chemical recycling technologies to obtain new high-performance packaging solutions. It provides useful insights to academics, managers, and decision makers in the plastic recycling sector whether (and under what conditions) the chemical recycling of multilayer plastic waste is feasible from the environmental, economic, and social perspectives. Despite associated uncertainties, the results are promising as an attractive option for further research, optimization, and upscaling.

Climate dissociations: Trade associations, energy policy and climate communications in Europe

This paper focuses on how climate delay narratives populate the information environment of decision makers and regulators in EU policy making. We examine the communications of selected trade associations representing oil and gas extraction interests in Europe. Our analysis offers a novel synthesis, drawing on official data, industry and social media content, using mixed methods and informed by recent theorising on the advocacy activities of trade associations. The paper contextualises the lobbying and communication activities of oil and gas trade associations in Europe using publicly available data on lobbying (drawn from the EU transparency register) and the outputs of oil and gas trade associations (in trade, specialist and social media) to examine their preferred framings and promoted policy prescriptions for addressing climate and energy policy. We find that trade associations representing oil and gas interests in Europe spend millions of euros per annum producing and promoting policy ideas that seek to secure the long-term future of these industries. Wider climate science is rarely directly referenced or acknowledged in their public advocacy. We argue that the normalization of a new form of climate denial has emerged, based on unproven technologies and market mechanisms being pushed by powerful economic interests.

Matrix Theory Approach to Fuzzy Hypersoft Set in Multi-Criteria Airline Selection

When we talk about decision-making then it means we have to tackle the attributes and alternatives, and it becomes difficult when attributes are further subdivided. The hypersoft theory allows us to handle further bifurcated attributes. This paper is aim to provide the legal way to deal with multi-criteria decision-making (MCDM) problems in the sense of further subdividing attributes by applying the concept of fuzzy hypersoft matrices (FHSM’s). Since matrices provide us with a fast and reliable way to solve problems. In this paper, we have proposed the concept of FHSM with their operators, theorems, propositions, and decision-making (DM) algorithms. The proposed algorithms have been supported with real-life application of airline selection while you have to take any flight. The concept of further bifurcation gives more accurate and refined results than the existing techniques, along with the implication of FHSM. In the future, the proposed concept can be implemented in other hybrids of hypersoft set theory with DM algorithms. The challenges faced in implication can be dealt with machine learning algorithms for fast and more accurate results.

No free entry: stomatal state as decision maker in defining stress response strategies.

No free entry: stomatal state as decision maker in defining stress response strategies.

What happened next? A survey of review clients evaluating impacts of rapid reviews.

End-user evaluation of the impact of evidence syntheses is critical to demonstrating value. This study presents results of a survey evaluating the impact of rapid reviews undertaken by two teams based in Melbourne, Australia and Hamilton, Canada. Clients were invited to participate in a short, written survey following delivery of a rapid review. Survey items encompassed reach, usefulness and format; interactions with the review teams; and overall satisfaction. Twenty-five completed surveys from 53 invitations were received pertaining to 19 rapid reviews conducted between September 2021 and October 2023. Topics encompassed COVID-19, health and behaviour change; reports were an average of 31 pages; and were delivered over an average of 62 days. Evaluation findings were positive, with high satisfaction with reports and service delivery; very high satisfaction with report structure and length; good evidence of reach (reports read by decision makers and cited in other documents); and evidence that the rapid reviews made contributions to strategic planning, policy and program funding decisions. Rapid reviews are making impactful contributions, alongside other inputs, to policy and practice. Further research is required to build this evaluation dataset; examine the balance between timeliness and methodological rigor in evidence synthesis; and explore models of delivery and capacity within and outside of government. It is also critical to promote implementation efforts to harness the full potential of rapid reviews and other evidence syntheses to impact the lives of citizens.

The Maaloop Framework: Enabling a Systems‐Level Common Operating Picture in Multiagency Disaster Management

ABSTRACTEmergency management operations are a complex system involving multiagency hierarchical command structures requiring coordination of significant volumes of information, resourcing and effort across expansive disaster zones within restricted timeframes and with potentially catastrophic consequences. Within these environments establishing a timely and shared understanding among different levels of command and across agencies is crucial yet remains a significant challenge. The problem is subsequently framed as ʻhow can the establishment of a systems‐level common operating picture across hierarchical commands and different agencies be improved in the context of complex emergency management and disaster response?ʼ To address this, we present the Maaloop Framework which builds upon the insights gained from previous research within the context of threat assessment, sensemaking, and critical decision‐making in police, military, ambulance, and firefighting contexts. To the observer trained in its application, it aims to provide an instant, point‐in‐time, global and detailed visual intelligent product of (i) the amount of information identified by decision makers at each location; (ii) how confident those decision makers are in the information and its application to resolve an incident; (iii) how the decision maker in adjacent command levels are using the information being fed to them. In turn, it will assist in improving individual and collective understanding regardless of position within a command hierarchy or agency jurisdiction. We submit that the Maaloop Framework does no more than describe the common constructs and concepts identified in the literature describing decision‐making within these industries and the broader study of decision‐making in the field of psychology. Therefore, this framework is intended to provide a solution to provide systems‐level common operating picture and an initial basis for increased communication and understanding across complex crisis events.

Guidance for an Effective Approach to Integrated Evidence Planning in a Dynamic World.

The value of a medicine is defined by its impact on patients, caregivers, health system, and society. A pharmaceutical company will generate evidence to demonstrate this value in various studies, including randomized clinical trials, non-interventional and observational studies, real-world data analyses, modeling, and simulation. The quality and strength of the evidence supporting a medicine's effectiveness, safety and product quality will drive decisions by healthcare system stakeholders for marketing authorization (regulatory authorities). Additional evidence of comparative clinical, humanistic, economic, and societal value of the medicine will be critical for reimbursement coverage by HTA (health technology assessment) bodies and payers, guideline inclusion by clinical societies, and ultimately the treatment decision between a patient and their healthcare provider (HCP). The purpose of this article is to provide practical guidance for an effective approach to evidence planning for pharmaceutical companies. In the first section, we give a brief overview of the requirements for evidence generation from the perspectives of healthcare system decision makers, key functions involved in evidence generation within a pharmaceutical company, and different archetypes of products. We then discuss how a company can implement effective integrated evidence planning across the lifecycle of a product. We also review how requirements are likely to evolve given recent changes in major healthcare system regulations, such as Centers for Medicare & Medicaid Services (CMS) drug price negotiations in the US and EU HTA Regulation (HTAR) in Europe, and finally provide some practical recommendations of how to start implementing a new integrated evidence approach.

Conservation-led palaeolimnology: a review of applied palaeolimnology and lessons to improve accessibility and value to conservation practice

AbstractThe integration of palaeolimnology into conservation practice is crucial for effective ecosystem management and restoration. Palaeoecological data provide a unique long-term perspective on key ecological challenges and enable decision makers to better understand pre-disturbance conditions, natural system dynamism and responses to change. Despite this there exist well-recognised accessibility issues and a clear research-implementation gap, in particular, poor communication and lack of understanding of conservation practitioners’ constraints. This study evaluates the accessibility and value of palaeolimnological research to conservation practice by interrogating 60 key applied research papers identified via a rigorous pre-screening process to ensure relevance. The papers were assessed on the use of best practice accessibility criteria, from knowledge-exchange literature, and conservation-practitioner feedback was gathered on the value of conservation recommendations made within the papers. Despite widespread recognition of the importance of accessible research, our review reveals that essential accessibility criteria are inconsistently applied. Although there has been an increase in accessibility practices over time, co-production practices (including co-authorship, co-design of research, and linkage to relevant environmental legislation), showed no significant increase, despite being advocated for by the research community. Practitioner review highlighted the need for research to provide clear, actionable recommendations, and papers that detailed specific management or restoration guidance were particularly well-received, as were those that considered financial implications and summarised their findings more clearly. Equally, many papers were criticised for overly technical language and poor expression, generic suggestions, and a lack of practical consideration in their recommendations. The study highlights the importance of improving accessibility and co-production of knowledge to ensure that research outputs are accessible, relevant, and feasible to guide conservation efforts. To enhance the relevance and impact of applied palaeolimnology, we propose five key recommendations: (1) situate recommendations within existing practice and knowledge; (2) consider the practicalities for practitioners, including material and socio-economic aspects; (3) use clear and simple language; (4) employ easy-to-interpret diagrams and bullet points for recommendations; and (5) improve accessibility of older work. These recommendations are key in helping palaeolimnology progress towards a ‘gold standard’ of applied research, where it can be employed to greater effect to support conservation practice.

Mobile clinics routing and scheduling in the Witzenberg region of South Africa.

Despite much literature on operations research applied to various healthcare problems, impactful implementation in public healthcare is limited, which often results in allocative inefficiency. This article uses a mobile clinic routing and scheduling problem in the Witzenberg region of South Africa as a case study to demonstrate the improvement of implementation success through cross-disciplinary collaboration, and also to propose a new three-stage approach for modelling a mobile clinic problem that incorporates continuity of care, fairness, and minimisation of distance travelled. Mobile clinics are used in many countries to improve access to healthcare for rural communities. Decision makers must assign farms or villages to mobile clinics, and determine their monthly visit schedules. To improve implementation success, we follow a collaborative three-phased mixed-methods approach with healthcare professionals to improve workload balance, fairness, and transportation cost. During phase 1, qualitative and quantitative data are gathered through qualitative research methods. In phase 2, fairly distributed optimal routes and schedules are designed using a three-stage model that incorporates a multi-vehicle routing problem to determine daily routes, a knapsack problem to establish a fair allocation of these daily routes between different clinics, and another variation on the vehicle routing problem to determine the monthly visit schedule that minimises the distance between the last farm visited on each consecutive day in the case of having to return to a farm the next day. Different input parameter estimations result in different routes and schedules. In phase 3, AHP is performed with main decision makers to determine their preferred solution. Final routes and schedules are designed based on model results, AHP results, and contextual input from decision makers. In our case study, an improved workload balance, a 23% reduction in total distance travelled, and buy-in to implement the changes, were obtained.

Correction to: Ruled by robots: preference for algorithmic decision makers and perceptions of their choices

Correction to: Ruled by robots: preference for algorithmic decision makers and perceptions of their choices

Prenatal vitamin utilization and its determinants among pregnant women in south Gondar zone: multicenter cross-sectional study.

Prenatal vitamin and mineral supplements are commonly advised as clinical practice standard of care. In spite of Ethiopian government focus on maternal nutrition programmes targeting pregnant and lactating women, Micronutrient deficiencies are still quite common and are regarded as a serious public health issue and also little is known regarding utilization and barriers to prenatal vitamin use during pregnancy. This study aimed to assess utilization and associated factors of prenatal vitamins among pregnant women attending antenatal care at public hospitals in the south Gondar zone, 2024. Multi center crossectional study design was conducted among 416 pregnant women from March 1 to May 30, 2024. Systematic sampling technique was used to select the study participants. Data was collected using Interviewer administered questionnaire. After data, SPSS version 26 software was used for analysis. Factors associated with utilization of prenatal vitamins were identified using bi-variable and multi variable logistic regression models. Statistical significance was declared at 95%CI and p-value < 0.05. In this study, we found that 87.5% (95% CI: 84.31, 90.34) of pregnant women did not use prenatal vitamins. Women not having formal education (AOR = 2.72, 95%CI: 1.44-5.15), being unplanned pregnancy (AOR = 2.58, 95%CI: 1.76-3.78), husband being decision maker in health care (AOR = 1.71, 95%CI:1.09-2.68), having poor knowledge (AOR = 3.27, 95%CI: 1.44-7.42) and unfavorable attitude (AOR = 3.63, 95%CI: 1.61-8.18) on prenatal vitamins were significantly associated with non-users of prenatal vitamins. The proportion of non-users of prenatal vitamin were higher. Educational level of women, pregnancy plan, decision on health care, knowledge and attitude on prenatal vitamins had statistically significant with utilization of prenatal vitamins. Developing and implementing targeted educational programs to increase awareness about the importance and benefits of prenatal vitamins and encouraging women to take an active role in their healthcare decisions is recommended to improve the utilization of prenatal vitamins.

Comparative technoeconomic analysis of centralised and decentralised water source heat pump systems using CATHeaPS.

In the efforts to decarbonise the heat sector, heat pumps can offer a cost-effective transition away from fossil fuels. Water Source Heat Pumps (WSHP) can be utilised in cases where ambient water sources (river, ground water, abandoned mines water) are present. However, the economic benefits of different levels of heat pump centralisation as well as their comparative advantages over other decentralised options such as individual Air Source Heat Pumps (ASHP) or Gas Boilers (GB) remain uncertain and further investigations are necessary to fully assess their potential. This study introduces CATHeaPS, a Centralisation Analysis Tool for Heat Pump Systems, a user-friendly open access modelling tool that enables the technoeconomic assessment of (a) district heating networks with a centralised WSHP, and (b) ambient networks with decentralised building level WSHPs against individual ASHPs and GB for a range of consumer classes. CATHeaPS provides a complete project cashflow for each supply option and is verified against published data and outputs from a UK industrial case study, with slightly altered data to ensure confidentiality. A data analysis highlights the break-even points for the number of residential properties, beyond which centralised solutions are more economic than decentralised energy supply options for different housing densities. A thorough sensitivity analysis is also conducted to identify the impact of different input parameters on the levelised cost of energy of each supply option. It is found that discount rate has the largest impact for both networks, followed by CAPEX and energy costs. This study aims to help stakeholders and decision makers in two ways. It introduces a novel, easy-to-use open access technoeconomic tool that enables a high-level analysis of energy, hydraulic and economic factors for any project area. Furthermore, it maps the boundaries of beneficial operation for different levels of centralisation for residential consumers and gives preliminary suggestions on which energy supply option is better suited to a given project.

Barriers, Potential Use, Competitiveness, and Implementation Framework of Building Information Modeling (BIM) in the Construction Industry of Pakistan

The use of building information modeling (BIM) in construction industry is believed to help decision makers throughout the project. The building sector in Pakistan is trying to adopt BIM as a tool to enhance the efficiency of projects. However, its actual implementation is being hampered by a number of barriers. Therefore, the purpose of this study is to identify those barriers and propose a framework to ensure its implementation. Data was collected through a questionnaire. Forty-nine (49) responses were collected and data was then analyzed using ANOVA to identify any significant differences in the opinions of different experts. Mean score and relative importance indices of all variables were determined. It is found that the major barriers include lack of expert knowledge, outdated contractual system and use of traditional tools for drafting. Further, the potential use of BIM is found to cause a reduction in rework as well as tool flexibility to allow different people to work at the same time. Moreover, a framework for BIM implementation on building projects include adding clauses in contracts, enhancing the awareness among industry stakeholders, and providing training and financial support. So, the findings of the current study will be helpful to pave the way for technological advancements in building projects in Pakistan. Keywords: Building information modeling (BIM), Potential benefits, Competitiveness, Barriers, Implementation framework.

Leadership competencies in public health: implications for nursing leadership – a scoping review

Purpose Effective leadership in public health organisations is essential for achieving positive outcomes and ensuring the quality of healthcare services. This review aimed to identify the competencies that nurse leaders of organisations working in the field of public health need to perform their tasks effectively. Design/methodology/approach A descriptive method with a scoping review was used, searching the PubMed, ScienceDirect, and CINAHL databases. A total of 16 references were suitable for the final analysis. A summative literature analysis was conducted, identifying leadership competencies (N = 69) across various sources. The identified competencies were analysed by qualitative approach. Findings Competencies were categorised in 11 groups: Identifying Needs and Continuous Improvement; Strategic Planning in Line with Vision and Mission; Ensuring Professional Development; Maintaining Motivation; Delegating and Managing Tasks; Communication Skills; Building and Maintaining Relationships with Decision Makers; Problem Solving and Conflict Management; Tracking Professional Trends and Using Accurate Information; Resource Management and Human Resource Management; Organising Work. Originality/value The 11 groups of leadership competencies for nurses in public health organisations provide a content direction for educational activities aimed at nurse leaders and summarise the most important competencies required for effective leadership in public health organisations. Competent leadership is vital for the success and effectiveness of public health organisations in delivering quality healthcare services and addressing the evolving healthcare needs. Further research within specific field in public health is recommended to identify additional, field-specific competencies essential for effective leadership in diverse organisational settings.

A novel Q-neutrosophic soft under interval matrix setting and its applications

Decision-making theory serves as an effective framework to guide decision-makers in solving problems. One notable application of this theory is in the medical field, where it aids doctors in analyzing patient data to determine whether a patient is infected. To enhance this theory with more adaptable mathematical methods, we propose an expanded approach based on previously introduced matrixes of Q-neutrosophic soft under an Interval-valued setting (IV-Q-NSM). This represents a new finding of existing mathematical tools to address the two-dimensional uncertainty prevalent in various life domains. This work explores several algebraic properties and matrix operations associated with IV-Q-NSM. Subsequently, we introduce a new methodology for decision-making (DM) in medical diagnosis selection problems. This approach aims to provide a more flexible and comprehensive framework for evaluating complex medical data and improving diagnostic accuracy.

Michigan tobacco cessation champions: A rapid qualitative analysis.

Smoking is the leading cause of preventable death in the United States. We interviewed Tobacco Cessation Champions, multi-sector decision makers, across the state of Michigan to assess and identify barriers and facilitators of smoking cessation and the current smoking cessation landscape. Twenty Tobacco Cessation Champion interviews (n=20) were completed with multi-sector decision makers to assess implementation barriers and facilitators from May 2022 to September 2023. We used rapid qualitative analysis to identify common themes across the Tobacco Cessation Champion interviews. Three key themes were identified across the Tobacco Cessation Champion interviews: 1) Facilitators and Barriers of Smoking Cessation Efforts; 2) Smoking Cessation Efforts: Underfunded, Underutilized, Not Marketable or Accessible, and 3) Need for more inclusive, person-centered smoking cessation interventions. Across the themes identified in the present report, champions identified myriad areas for improvement in the tobacco cessation landscape, including: Appeal, accessibility, and the functionality of current systems. The community should strive to improve trust and relationships between providers and patients, as the trust established between these parties is imperative for promoting tobacco cessation. Lastly, cessation efforts should aim to address and improve attitudes and stigma toward smoking and tobacco cessation.

Marine and atmospheric transport modeling supporting nuclear preparedness in Norway: Recent achievements and remaining challenges.

Numerical transport models are important tools for nuclear emergency decision makers in that they rapidly provide early predictions of dispersion of released radionuclides, which is key information to determine adequate emergency protective measures. They can also help us understand and describe environmental processes and can give a comprehensive assessment of transport and transfer of radionuclides in the environment. Transport of radionuclides in air and ocean is affected by a number of different physico-chemical processes. Along with uncertainty arising from the input data, the model estimates will therefore involve a combination of numerous uncertain factors, caused by knowledge gaps and assumptions in the model system. As discussed in this paper, the major sources to uncertainty affecting the model results are release descriptions, driving data, process descriptions and parameters. Here, we give a synthesis of the most important improvements in atmospheric and marine models achieved through the CERAD programme. In the atmospheric transport model, an important improvement has been inclusion of uncertainties in the dispersion estimates. Recent developments also include adaption to high resolution forcing data and ensemble forecasts, inversion methods and long term analyses. Case studies clearly show improved predictions from ensemble mean values compared to single deterministic runs, and promises for future upgrades of preparedness decision support systems. A major improvement in the marine model system was implementation of dynamic speciation including transformation of species, identifying particle size and parameterizations to be key factors affecting radionuclide distribution. The model system was further developed in a case study involving the impact of changing environmental factors on the transport of aluminium river run-off to an estuary in southeastern Norway. Suggestions for future improvements include implementation of an operational preparedness model for marine transport, better quantification of uncertainties using ensemble methods and improved source identification with further development of inverse transport.

ED observation unit-based delayed comfort care pathway for ED patients on life support.

Critically ill ED patients on life support may undergo transition to comfort care as decided by the surrogate decision maker. When several hours are needed for loved ones to arrive and say farewell before initiating comfort care ("delayed comfort care"), these patients require prolonged ED stays or costly intensive care unit (ICU) admissions. A novel ED observation unit (EDOU)-based delayed comfort care pathway for ED patients on invasive mechanical ventilation and/or vasopressors was created in 2013 at Stanford Hospital. Inclusion criteria are: agreement by the surrogate decision maker to no titration of life support and initiation of comfort care within 18h of EDOU admission. Exclusion criteria are: potential for organ donation and lack of a private room or nursing resources in the EDOU. Feasibility was assessed by analyzing the electronic health record for all patients who utilized the pathway between 8/2013 and 2/2023. The primary outcome was the proportion of patients who had initiation of comfort care after all expected loved ones arrived to the bedside. We also analyzed patient characteristics, clinical operation data, and safety data. 23 patients were identified in the study cohort. The average patient age was 76, and 48% were female. Three ED diagnoses for the cohort were intracranial hemorrhage (57%), cardiac arrest (26%), and respiratory failure (17%). All patients were intubated, and six were also on vasopressors on arrival to the EDOU. 100% of patients had all expected family members arrive to bedside prior to initiation of comfort care. All patients had initiation of comfort care within 18h of EDOU admission (median time from EDOU arrival to extubation 1.1h (IQR 0.2-3.2)). No patients had adverse events in the EDOU, died before comfort care initiation, or were transferred to ICU. The EDOU-based delayed comfort care pathway is a feasible way to deliver compassionate end of life care for patients on life support. It can be considered in hospitals with an EDOU especially if their private ED beds and ICU resources are scarce.