Accountability for Reasonableness for Priority Setting

Accountability for Reasonableness for Priority SettingEssayAccountability for Reasonableness, for priority setting and resource allocation.INTRODUCTIONPakistan as a underdeveloped kingdom has very limited health reverence resources whenconsidering a huge population of over 170 million. We have very few tertiary economic aidhospitals and they are providing services to the whole country. Majority of people inour country are poor and they are unable to afford the expenses of mysterious hospitals,though private hospitals are also very few. Thousands of doctors are unemployedand still we have shortage of doctors. Majority of BHU (Basic Health Units) areclosed as majority of doctors live to urban areas and they dont want to work inremote village areas. In all these situations, it is very difficult to maintain healthcare throughout country. In this essay, I provide make out into account four conditions ofaccountability for tenability for priority setting and resource allocation. I leave behindtake into account these four conditions by Norman Daniels and I leave consider atertiary care hospital scenario where I did my house job in medicine ward last year.There were majority of affected roles suffering from chronic liver diseases (CLD). I willfurther continue this essay in discussion. paroleBefore discussing the four conditions of accountability for reasonableness, I willbriefly discuss the case scenario. In my medicine ward as I earlier give tongue to majority ofpatients were of chronic liver diseases (CLD) and it includes Hepatitis B, Hepatitis Cand cirrhosis of liver. Cirrhosis is the end conduce of hepatocellular injury that leadsto both fibrosis and nodular regeneration throughout the liver. The clinical featuresresult from hepatic cell dysfunction, portosystemic shunting, and admissionhypertension. Cirrhosis may cause no symptoms for long periods. One of the majorcomplications is uppergastrointestinal tract bleeding which may occur from varices,po rtal hypertensive gastropathy, or gastroduodenal ulcer. Hemorrhage may bemassive, resulting in fatal exsanguinations or enencephalopathy. Esophageal varicesare found in 50 % of patients with cirrhosis. There are several treatment andmanagement options available for esophageal varices including acute resuscitationas initial management, pharmacologic therapy, balloon tube tamponade, portaldecompressive procedures and emergent endoscopy. Endoscopic techniques are alsoused for prevention of Rebleeding. 1. Now, I will discuss my case scenario. In ourhospital there is unrivalled associate professor who is trained in doing endoscopy andWednesday is fixed for performing endoscopies. Emergent endoscopy is performedafter the patients hemodynamic status has been appropriately stabilized (usuallywithin 2-12 hours). Majority of poor patients come to hospital in end stage liverdiseases. I have taken this case series as it is a perfect example of scarce resources.Many patients face problems as t heir endoscopies were not performed on time asthere was only one day fixed in a week. Now I will apply the four conditions ofaccountability for reasonableness for priority setting and resource allocation. Thesefour conditions are publicity condition, relevance condition, revisions and appealscondition and regulative condition. Accountability for reasonableness makes itpossible to educate all stakeholders roughly the substance of deliberation about fairdecisions under resource constraints. It facilitates social learning about limits. Itconnects decision making in healthcare institutions to broader, more fundamentaldemocratic deliberative processes. 2. In my case scenario I will apply the fourconditions as follows. The first one is publicity condition. It states that decisionsregarding limits to care and their rationales must be publicly accessible to clinicians,patients, and citizens in a publicly administered system. When the patients sufferthe complication of esophageal varices, t hey are informed about the limited capacityof the ward to arrange endoscopy as it is through on only Wednesdays and surgicalward have their own burden of patients to be done endoscopies, due to this reasonwe were unable to send patients to surgical wards and the patients and theirrelatives mostly agrees on this setup and if their was any emergency only then wetake help from surgical ward or send the patients to any other hospital, so the firstcondition is runed. In above scenario second condition is also fulfilled which isrelevance condition. It states that the reasons for limit-setting decisions will bereasonable if it appeals to evidence, reason, and principles that are accepted asrelevant by fair-minded people who are disposed to finding mutually justifiable harm of cooperation. In my case scenario the decision making is according to theframework. The rationales were reasonable as it is evident that we had limitedfacility of endoscopy and it was fairly accepted by patients and their relatives andalso by doctors and other hospital staff. In our setup priority was given to thosepatients who needed emergency endoscopy rather than those who requiresendoscopy for diagnostic procedures. The third condition is revisions and appealscondition. This condition is a very common problem in government hospitals and inour scenario we request consultants from surgical ward to do emergency endoscopyif we think patient is serious and he or she may die if the endoscopy is notperformed on time or in other case the other hospital is very far so that it will be lateif we send the patient to other setup and here comes the function of oncallconsultants also, the oncall consultants plays huge role in these emergencysituations. This third condition is a mechanism for challenge and dispute resolution regarding limit setting decisions, including the opportunity for revising decisions inlight of further evidence or arguments. 3. Thus we fulfill the third condition also byrevising our decisions as I explained above. The fourth and last condition isregulative condition or enforcement. There is all voluntary or public regulationof the process to ensure that conditions 1-3 are met. This condition is also fulfilled inour setup as we communicate with the patient and their relatives about our limitedresources. We are able to convince patients in our case scenario. The hospitalleadership is constantly making efforts to meet the conditions of accountability forreasonableness. 4. oddmentIn this essay I have discussed all four conditions of accountability forreasonableness, for priority setting and resource allocation. Accountability forreasonableness is a framework that faeces be used to guide legitimate and fair prioritysetting in health care organizations, such as hospitals. In our beloved countryPakistan we have few government civil hospitals bearing the burden of millions ofpopulation. We try our best to server the humanity. Iam not claiming this system aperfect on e, it needs a lot of improvement and the example is my case scenario inwhich we have very limited resources. Government should establish civil hospitals insmall cities also and should emergence their budget they should recruit more doctorsand nurses as we have shortage. They should train doctors with latest equipmentsand provide hospitals appropriate medicines. In addition to this all the hospitalsshould be provided with computers and also be made online so that a data systemcan be established and it can help the patients and also hospitals for futurereference. I will pause by saying that in such scarce resources, government sectorhospitals are doing excellent job.REFERENCESCurrent Medical Diagnosis and Treatment 2004. 43rd edition.Norman Daniels. (2000). Accountability for reasonableness. BMJ 321 1300-1301.D K Martin, P A Singer and M Bernstein. (2003). Access to intensive careunit beds for neurosurgery patients a qualitative case study. J. Neurol.Neurosurg. psychological medicin e 74 1299-1303.Jennifer AH Bell, Sylvia Hyland, Tania DePellegrin, Ross EG Upshur, MarkBernstein and Douglas K Martin. (2004). SARS and hospital priority settinga qualitative case study and evaluation. BMC Health Services Research, 436