Emergency Medicine

Consent, Competence and Refusal of Treatment

Administrative and Legal Issues 451

3 Children and patients who are in pain may be up-triaged to a more acute

category to facilitate expeditious care. Psychiatric patients are triaged

according to a Mental Health Triage Scale.

4 A patient’s triage category underpins sentinel ED performance indicators,

such as waiting time (by triage category), admission rate, and ‘did not wait’

(DNW) rate, and aids the prediction of optimal staffing levels, resources,

space and budget requirements.

CONSENT, COMPETENCE AND REFUSAL OF TREATMENT

Consent and competence

1 Consent may be implied, verbal or written. However, to be valid it must be

informed, specific, freely given and cover what is actually done, and the

patient should be mentally and legally capable of giving it.

2 Patients >16 years in many circumstances, and 18 years in most, may sign or

withhold their own informed consent. This may be done under common law

principles or as set out in local legislation, provided they are deemed compe-

tent to do so.

3 Competence requires capacity to understand what is proposed, the options

involved, the treatment and the risks of treatment or lack of it, the possible

outcomes, and to be able to maintain and communicate a choice.

Table 17.1 Australasian triage scale

Designation Treatment acuity Numeric code

Resuscitation Immediately 1

Emergency Within 10 min 2

Urgent Within 30 min 3

Semi-urgent Within 60 min 4

Non-urgent Within 120 min 5

Table 17.2 UK national triage scale

Designation Treatment acuity Numeric code

Immediate resuscitation Immediately 1

Very urgent Within 10 min 2

Urgent Within 60 min 3

Standard Within 120 min 4

Non-urgent Within 240 min 5