There are a number of system and organizational issues that seem to be contributing to the Moral Distress in this case when you look to determine the root causes of the distress that health care providers are experiencing. These include questions of where certain types of care should be provided; could noninvasive ventilation be offered outside the ICU, for example, and is there a way to collaborate with the local continuing care organizations to reduce these admissions? Are there hospital processes that could be shifted to make more effective use of available resources such as ICU beds? Most of these patients are coming in through the Emergency Department; are there processes there that are affecting these outcomes?
You recognize that these systemic issues need to be dealt with, and report during the consult that you will be forwarding some recommendations about addressing the underlying systemic issues to senior leadership through the reporting process. You describe the systemic and organizational issues that you have identified and ask the group if there’s anything that they’d like to add, but indicate that the focus of the consult will be on clinical decision making.
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