Clinical ethics and the quality initiative: a pilot study for the empirical evaluation of ethics case consultation.
The Institute of Medicine's quality imperatives include the need to provide safe, effective, patient-centered, timely, efficient, and equitable care. Less attention has been paid to quality metrics as they relate to the assessment of clinical ethics consultation and its impact on care. A better understanding of how ethics consultation influences the quality of care might identify opportunities for improvement. A descriptive pilot study, involving 7 hospitals in the New York-Presbyterian Healthcare System, was conducted to identify key elements of the ethics consultative process that might impact clinical and psychosocial outcomes. A majority of consults involved medical or intensive care unit patients and end-of-life decision making; 75.5% had or received a do-not-resuscitate order, 90.6% lacked decision-making capacity, 43.4% had an advance directive. Conflict existed in a majority. Future research should include surrogate decision making, patients on nonmedical services who may have unrecognized ethical dilemmas, and the role of conflict in clinical care.
Nilson
Elizabeth G
EG
Division of Medical Ethics, Weill Medical College of Cornell University, New York, New York, USA. eln2004@med.cornell.edu
Acres
Cathleen A
CA
Tamerin
Naomi G
NG
Fins
Joseph J
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003220:Conflict, Psychological; D003657:Decision Making; D033061:Ethics Consultation / Q000458:organization & administration*; D026690:Ethics, Clinical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011787:Quality of Health Care / Q000458:organization & administration*; D016414:Resuscitation Orders / Q000941:ethics; D013727:Terminal Care / Q000941:ethics*; D013997:Time Factors