Accountability for Reasonableness for Priority Setting

office for Reasonableness for Priority Setting demonstrateAccountability for Reasonableness, for antecedence context of use and imaginativeness wholeocation.INTRODUCTIONPakistan as a developing country has very seted health cargon resources whenconsidering a huge population of over 170 million. We have very hardly a(prenominal) tertiary c are hospitals and they are providing services to the whole country. Majority of pot inour country are poor and they are unable to support the expenses of private hospitals,though private hospitals are as well as very few. Thousands of doctors are unemployedand still we have shortage of doctors. Majority of BHU (Basic Health Units) areclosed as majority of doctors belong to urban areas and they dont want to work inremote village areas. In every last(predicate) these situations, it is very difficult to maintain healthcare throughout country. In this essay, I will fulfill into sexual conquest four coachs ofaccountability for modestness for priority context of use and resource allocation. I willtake into account these four conditions by Norman Daniels and I will consider atertiary care hospital scenario where I did my house job in medicine cover last year.There were majority of patients suffering from inveterate liver diseases (CLD). I willfurther continue this essay in discussion.DISCUSSIONBefore discussing the four conditions of accountability for skill, I will concisely discuss the case scenario. In my medicine ward as I earlier said majority ofpatients were of chronic liver diseases (CLD) and it includes Hepatitis B, Hepatitis Cand cirrhosis of the liver of liver. cirrhosis is the end result of hepatocellular injury that leadsto both fibrosis and nodular vicissitude throughout the liver. The clinical featuresresult from hepatic cell dysfunction, portosystemic shunting, and portalhypertension. Cirrhosis may cause no symptoms for long periods. One of the majorcomplications is uppergastrointestinal footpath bleeding which may occur from varices,portal hypertensive gastropathy, or gastroduodenal ulcer. run may bemassive, resulting in fatal exsanguinations or enencephalopathy. Esophageal varicesare found in 50 % of patients with cirrhosis. There are several discussion 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 one associate professor who is trained in doing endoscopy andWednesday is fixed for performing endoscopies. Emergent endoscopy is performedafter the patients hemodynamic location has been appropriately stabilized (usuallywithin 2-12 hours). Majority of poor patients come to hospital in end stage liverdiseases. I have interpreted this case series as it is a sinless example of meagre re sources.Many patients faced problems as their 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 forwarding condition, relevance condition, revisions and appealscondition and regulatory condition. Accountability for reasonableness makes itpossible to educate all stakeholders closely the substance of deliberation about fair endings under resource constraints. It facilitates social learning about limits. Itconnects decision making in health care institutions to broader, more fundamentaldemocratic deliberative processes. 2. In my case scenario I will apply the fourconditions as follows. The first one is unexclusiveity 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 patien ts sufferthe complication of esophageal varices, they are informed about the restrict capacityof the ward to arrange endoscopy as it is done on only Wednesdays and surgicalward have their own hindrance of patients to be done endoscopies, due to this reasonwe were unable to send patients to surgical wards and the patients and theirrelatives broadly agrees on this apparatus and if their was any emergency only then wetake suffice from surgical ward or send the patients to any otherwise hospital, so the firstcondition is fulfil. 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 leaven, reason, and principles that are genuine asrelevant by fair-minded people who are accustomed to finding mutually justifiableterms of cooperation. In my case scenario the decision making is according to theframework. The rationales were reasonable as it is evident that we had l imited facility 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 quite than those who requiresendoscopy for diagnostic procedures. The tercet condition is revisions and appealscondition. This condition is a very leafy vegetable 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 furth er 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 either 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 hospital leading is constantly making efforts to meet the conditions of accountability forreasonableness. 4.CONCLUSIONIn this essay I have discussed all four conditions of accountability forreasonableness, for priority setting and resource allocation. Accountability forreasonableness is a framework that tin 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 ofpopulati on. We try our best to server the humanity. Iam not claiming this system aperfect one, 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 increase their budget they should recruit more doctorsand nurses as we have shortage. They should train doctors with latest equipmentsand provide hospitals appropriate medicines. In appurtenance 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 conclude by give tongue to that in such scarce resources, government sectorhospitals are doing fantabulous 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). annoy to intensive careunit beds for neurosurgery patients a qualitative case study. J. Neurol.Neurosurg. abnormal psychology 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