case study of priority setting in cardiac surgery
Subtitle: complex, contextual and dynamic.
Published: 2004
Language: eng
Number of pages: 382
Description: Purpose. The purpose of this study is to describe priority setting in cardiac surgery and evaluate it using an ethical framework, "Accountability for reasonableness".Methods. Case studies were conducted to examine priority setting at three University of Toronto affiliated cardiac surgery centres. Relevant documents were examined, weekly triage rounds were observed for 27 months, and interviews were carried out with 23 key participants including cardiac surgeons, cardiologists, and triage nurses. In data analysis, the conditions of "Accountability for reasonableness" (relevance, publicity, appeals and enforcement) were used as an analytic lens.Conclusions. Priority setting decision making in cardiac surgery has been described and evaluated. Lessons learned include specific findings regarding the contextual and dynamic nature of decision making. In addition, the approach of combining a descriptive case study with the ethical framework of "Accountability for reasonableness" can identify best practices and highlight areas for improvement.Introduction. Cardiac surgery is an expensive part of hospital budgets. Priority setting decisions are made daily regarding ever increasing volumes of patients. While much attention has been paid to the management of cardiac surgery waiting lists, little empirical research exists into the way actual decision makers deliberate upon and resolve priority setting decisions on a daily basis. A key goal of priority setting, in cardiac surgical areas as well as others, is fairness. "Accountability for reasonableness" is a leading ethical framework for fair priority setting, and can be used to identify opportunities for improvement (i.e. make it fairer) and highlight best practices.Results. Relevance: While decisions may appear to be based strictly upon clinical criteria (e.g. coronary anatomy); non-clinical criteria also have an impact upon decision making (e.g. patients' lifestyle choices, type of surgical practice and departmental constraints on resource use). Participants stated that these factors influence their decision-making and can result in unfair and inconsistent decisions. Publicity: Non-clinical reasons are not publicly accessible, nor are they clearly acknowledged in discussions between cardiac clinicians. Appeals: There are mechanisms for challenging decisions however without access to the non-clinical reasons, this can be problematic. Enforcement: Participants cite little departmental or institutional support to engage in fairer priority setting.
Notes: Adviser:  Peter A. Singer.

Thesis (Ph.D.)--University of Toronto, 2004.

Electronic version licensed for access by U. of T. users.

Source: Dissertation Abstracts International, Volume: 65-05, Section: B, page: 2347.