The Sense of Urgency at the Hospital

Abstract

Hospital emergency services, initially created to accommodate acute and serious diseases, are now confronted by multiple requirements. They must not only respond to vital emergency situations, but also fill the gaps in the health and social services provided for benign conditions or social problems. Given the phenomena of chronic congestion, hospital policies are moving towards a restriction on intake for a core of serious diseases. Triage protocols permit the ranking of priorities on the basis of preestablished clinical criteria. But behind this normative model for priority setting stands a much more complex reality, susceptible to adaptations and arrangements that depart from strict official standards and respond to the particularity of the situations encountered. Based on a three-year immersive study in a hospital emergency service, this current paper shows that the management of priorities, far from depending only on regulatory standards, adapts and changes according to the habits and uses of hospital medicine. Faced with multiple requirements, professionals are confronted with genuine moral dilemmas and daily contradictions between solidarity, humanity, patient triage, managing priorities and economic imperatives. On a daily basis, emergency caregivers attempt to prioritize their actions by reconciling legal and organizational constraints related to their function. They face many ethical challenges that question the meaning of emergency, the responsibility towards risk and the challenges of the hospital institution.