Andrew Argent Criteria for admission and refusal to PICU

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A 4 RDaniels and Sabin, Health Affairs, 1998Martin and Singer, Health Care Analysis, 2003
Duty to provide careEquityTrustTransparencyConsistencyInclusivenessResponsivenessAccountabilityThe process was an attempt to provide care to as many children as possible,within the resources available. In South African law the principle has beenestablished that the health care services cannot provide all services to allpeople (Subramoney case)No particular groups were excluded. In fact attempts were made to improveaccess to care for children from outside the major teaching hospitals.Development of trust in the system is an ongoing concern and will have to bereviewed and assessedThe process was open to comment, and was made public to clinicians andmanagers within the health system. It was not transparent to the generalpublic, or to specific groups of people who were potentially (or actually)affected by the process. Where possible the rationale behind specificexclusions was provided in the documentationImplementation of a specific policy improved overall consistency, butindividual consultants were aware of some variability in their implementationof the policyThe process was focused primarily on health professionals, and there was notadequate involvement of other stakeholdersThere were mechanisms within the system to respond to changes incircumstances, and there were mechanisms established to appeal againstspecific decisions.The clinicians whose patients were affected by the process had everyopportunity to appeal against decisions. In reality this happened very rarely.Managers and administrators were given details of the implications of theresources available and the attempts to use those resources appropriately.
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Page 30 and 31: easons for refusalsn %no beds 95 65
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Andrew Argent Criteria for admission and refusal to PICU

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