Abstract Details

Title Triage in Stroke Units: Physicians Perceptions and Ethical Issues

Topic Ethics, Pain and Palliative Care

Presentation(s) P02 - (-)

Poster/Presentation
Number 008

Objective

Background BACKGROUND: Because they have demonstrated their efficiency to reduce morbi-mortality after stroke, stroke units have been created in France since 2000. Every patient with stroke should be admitted in one of these units. Due to their cost and to the limitation of medical demographics, their development has been limited: a bed in stroke unit can be considered as a scarce resource. How do the physicians face to this scarcity of resource ? How their admission decision is influenced by their own considerations or by their experience?

Design/Methods DESIGN/METHODS: 337 surveys were sent to physicians implicated in acute admission in stroke units in Parisian metropolitan area (neurologists and physicians from emergency medical services). The surveys comprised questions about conception of reasonable allocation of beds, and clinical vignettes (illustrating: dementia, a severe stroke in an aged patient, transient deficit, a doubtful stroke and a patient socially marginalised).

Results RESULTS: 162 surveys have been fully completed. There was a high discrepancy of conceptions and practice between neurologists and the emergency physicians. Triage was more important for the emergency physicians and was linked to the difficulty to orientate an old patient or a patient without indication to rt-Pa in a stroke unit.

Conclusions CONCLUSIONS: Despite a vocation to take care of all patients, triage practices are pointed out during stroke unit admission. They depend on the role of each physician in the acute stroke management. They are the integration of a distributive justice theory, of contextual data, but also of subjective clinician evaluation. The triage decisions are ineluctable because of the scarcity of resource but are complex and difficult to take for clinicians, because they face to the "rule of rescue". These medical choices involve also the values of the society.

Authors/Disclosures
Marion Yger PRESENTER	No disclosure on file
Sophie Crozier	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Yves Samson, MD	No disclosure on file

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