Applying Ethical Principles to Reduce Hospital Readmission

As health care workers we are sometimes faced with ethical problems in our careers. We must make sound decisions based on our moral values and principles. In the ethical principles of health Care ethics, we are guided in using four main popular principle approaches in the health care organization to serve our problems and treat our patients with respect. Give them the opportunity to make their own decisions and honor their core values and norms.

Overview of the Case Study

Caleb Powell is the chief executive officer for the Virginia County Regional Hospital. Caleb Powell is hosting an executive leadership meeting. On the agenda Powell will be discussing with his leadership team ways in which the hospital can reduce the readmission rate of patients. Powell believes that this is important for the future and success of the Virginia County Regional Hospital and it will also improve patient satisfaction and the hospital quality. The idea to reduce hospital readmission is based on an article Powell read from the National Institute of health discussing ways to reduce the readmission rate. This will be done across the board and not only areas identified by federal guidelines. Caleb Powell knows that there is more to gain if things go right or more to lose if things go wrong under the provision of the Affordable Care Act where hospitals are penalized for 30-day readmission for patients with heart attack, heart failure, and pneumonia. On the other hand, it is concerning to Powell that, this policy may avoid patients from seeking care when needed which will be an ethical issue.

Applying the Ethical Principles

It is important to identify the problems that are contributing to the patient readmission in the hospitals after being discharged within 30 days. In order to prevent hospital readmission, one should evaluate the situations, courses of action, and behavior. The patient with acute illness like heart failure and pneumonia must have a safe discharge order in place before returning home or back to the community to avoid concerns of just allocating of health care resources. Caleb Powell Has a range meeting with his executive board to discuss possible way of how to reduce hospital readmission.

Using the Ethical Decision-Making to Analyze the Case Study

It is important to identify the problems that are contributing to the patient readmission in the hospitals after being discharged within 30 days. In order to prevent hospital readmission, one should evaluate the situations, courses of action, and behavior. The patient with acute illness like heart failure and pneumonia must have a safe discharge order in place before returning home or back to the community to avoid concerns of just allocating of health care resources.

Using the three components of ethical decision-making model: moral awareness, moral judgment, and ethical behavior will help analyze this situation. In moral awareness we recognize the problems and the ethical dilemma that exists in hospital readmission for patient in health care providers. If the patient gets admitted to the hospital for pneumonia or heart failure they must be treated fully before being discharged home. As health care providers we must have the ability to detect and appreciate the ethical asset of the decision one must make. Hospital must first recognize the ethical dimension of an issue they face with patient readmission. Hospital readmission is an issue among the healthcare organization because they get penalized. Most readmission occurs among patients with acute medical needs that cannot be met elsewhere.

Now that the problems of patient's readmission are evident, a judgment can be made to decide what is right or wrong. The Affordable Care Act wants hospitals to improved quality and efficiency of patient care to lower health care cost and provide protection. In order to prevent hospital readmission, one should evaluate situations, courses of actions, and behavior. In ethical behavior one should demonstrate respect for key moral principles that include honesty, fairness, equality, diversity and individual rights. We want to know what is good and bad in the hospital and what is right and wrong. While trying to reduce hospital readmission the healthcare provider should respect the patient dignity, diversity and rights.

Resolving the Ethical Dilemma by Applying Ethical Principles

To employed ethical dilemma relating to health care the four ethical principles of autonomy which, give the patient the right to control over his or her body, make their own decisions whether the health care provider believes that these choices are in the patient's best interest or not, and respect this or her personal values and believes. Beneficence which means the health care professional must do all they can to benefit the patient in each situation doing the most good. Excepting the patient with CHF and not turning them away because of hospital gain. Non- Maleficence “to do no harm”, do not with hold treatment because of Financial problem. The principles of justice should be fairness in all decisions; treat all patients the same.

Patients with Pneumonia, heart failure, and heart attack should mostly fall in the acutely ill category. Hospitals are now having more physicians, physician groups, residents, social workers, PT, OT, and nurses that make-up the team of health care providers who are working to try and reduce hospital readmission. Caleb Powell and his executive can organize the same team to work towards his goals for the Virginia County Hospital. When discharging the patient with congested heart failure, they should be given a good detailing discharge education on what to do at home to prevent worsening of their CHF and readmission. The education should include weighing themselves first thing every morning when they get out of bed. They should urinate before weighing, don’t eat, wear lite clothes, and use the same skill. Educate patient to report any weight gain of 5 pounds or more within one week. They should make sure to rest between activities when working or exercise.

For patients with pneumonia, it takes up to six weeks to fully recover so, these patients will get antibiotic IV when admitted to the hospital and when they are discharge the doctor usually continue them on oral antibiotic. Teach patient to take all the antibiotic and prescribed until it is finished. Also teach patient to take deep breaths and cough several times during the day because this helps to loosen up mucus and get it out. Washing hands with soap and water after blowing their nose is very important. It is a good practice when coughing or sneeze to either use tissue or your elbow or sleeve.

When discharging patient admitted with heart attack their education should include lifestyle changes, good nutrition which can control weight and lower blood pressure and cholesterol. They should make it a habit to check their blood pressure every morning before taking the medications at the same time every day and continue with therapy and provide patient support system for the patient, family, and caregiver.

Make a follow up doctor’s appointment for the patient when they are being discharged from the hospital and be sure to call and follow up with the patient about their health and their appointment. These are some of the things that will help reduce patient hospital readmission and improve patient satisfaction which is the key metric for measuring hospital quality. The hospital should also consider medication reconciliation by ensuring that the patient home medication list is up to date as possible. This may include asking the patient, relatives, caregivers, primary care physician, and checking electronic medication records. This will prevent medication error during admission transfer and discharge orders. All these aggressive policies that is used to avoid the readmission of patients to hospitals, could cause ethical problems and also prevent patients from coming back into the hospital.

Analyzing the Ethical Issues in the Case Study

The ethical issues in this case study is Caleb Powell leadership meeting is most focused on the access of business and to make profit which is different from the ethic of health care of health care. Beneficence, doing good is very important for the patient. The patient is the primary interest of health care. Patients are being discharged from the hospital too early because they want to reduce hospital stay but sometimes interfere with quality hospital care. Sometimes healthcare professionals will compromise the ethics and standards by sending patients home or to skilled nursing facility sicker than working hard to improve their care.

Effectiveness of Communication Approaches in the Case Study

Communication plays of vital role in the health care system; Caleb email to his executive team is one of the good forms of communication. His email communication lays out the agenda of what will be discussed in the meeting and what to except. His list of things to be discuss are, readmission rate and reduction, no increase in the patient hospital stay, and not scaring the patients away from coming back to the hospital. Balance between reducing the hospital readmission and not increasing the time of hospital stay is going to be very challenging for Caleb and his executive team members. As stated early in the paper the acutely ill patients with high readmission rate needs more hospital time for hospital stay. In the meeting Caleb Powell will have to listen to what idea the other members have to offer and maintain an open communication.

Conclusion

The three ethical decision-making model: moral awareness which tells you is an ethical dilemma, making a judgment, we decide what is right or wrong, and the ethical behavior, we take action to do the right thing. In the health care system, there are four basic principles that we applied in our daily patient care: they are autonomy, beneficence, non-maleficence, and justice. Caleb Powell and his executive team are fully obligated to withhold these principles.