Effective communication is not a function of time but rather one of skill. Few extra seconds spent on each tasks are actually time efficient and can decrease inappropriate workup, interpersonal conflict, and litigation, and can enhance compliance with follow-up care [53]. Thus, though the time factor is generally blamed for this, this should not necessarily be the case because good communication

can be part of the triage process itself. As such, respect for autonomy may be realized as much as possible in ED situations. Nonmaleficence Inhibitors,research,lifescience,medical The principle of nonmaleficence can be described as “do no harm”. The Hippocratic Oath mentions this obligation as “I will use treatment to help the sick according to my ability and judgment, but I will never Inhibitors,research,lifescience,medical use it to injure or wrong them” [12]. One ought not to inflict evil or harm. Harm is not directly inflicted by triage except when hopelessly injured patients are considered

in the dead category. Even during disasters, under given circumstances; health care professionals are always obligated Inhibitors,research,lifescience,medical to provide the reasonably best care. The aim is to secure fair and equitable resources and protections for vulnerable groups [54]. Waiting long for a consultation can increase pain and suffering and, at times, worsen the outcome and thus, result in indirect harm. Psychosocial harm includes stress, fear, feeling neglected or not being taken care of. Triage guidelines aim to avoid harm to the patient by sorting the patients as quickly and Caspase pathway efficiently as possible. However, in emergency care, especially in situations Inhibitors,research,lifescience,medical of overcrowding, treating one patient might threaten the

welfare of another patient by not being able to take care of both. Studies in different centres have found Inhibitors,research,lifescience,medical an association between overcrowding and reduced access to care, decreased quality measures, and poor outcomes [55]. Sometimes, referral to other centres can result in more quick and effective service and thus, harm in the form of excessive delays may be avoided [18]. Furthermore, medical care is not only the diagnosis and treatment in emergency care; patients mafosfamide value effective communication and short waiting times over many other aspects of care [56]. Lack of communication of triage times and categories is one of the causes of aggression and violence of patients and accompanying persons towards emergency staff [57]. Crilly et al. reported around 67% of patients who exhibited violent behaviour either did not wait for treatment or had been in the emergency room for less than one hour [58]. Ekwall et al. suggest the importance of addressing the psychosocial needs of patients of varying levels of urgency through their social interactions at triage [59]. Existing triage guidelines [17,27] miss to incorporate this aspect of care, which can compromise the principle of nonmaleficence.