title: Use of the medical Ethics Consultation Service in a busy Level I trauma center: impact on decision-making and patient care.
abstract: The purposes of this study were to assess reasons for consultation of the Ethics Consultation Service for trauma patients and how consultations impacted care. We conducted a review of ethics consultations at a Level I trauma center from 2001 to 2010. Data included patient demographics,  etiology of injury, and timing/type of the consult, categorized as: shared decision-making, end-of-life, privacy and confidentiality, resource allocation, and professionalism. Consultations were requested on 108 patients (age mean, 46.5 ± 20 years; Injury Severity Score mean, 23 ±  14; length of stay [LOS] mean, 44 ± 44 days), 0.50 per cent of all trauma admissions. Seventy-seven per cent of consultations occurred in the intensive care unit. End of life was the most common consultation (44%) followed by shared decision-making (41%). Average time to consultation  was 25 days. Shared decision-making consults occurred much earlier than end-of-life consults as evidenced by a lower consult day/LOS ratio (consult day/LOS = 0.36 ± 0.3 vs 0.77 ± 0.3, P = 0.0001). Conclusions consisted of: 1) ethics consultation on trauma patients  are most commonly for end-of-life and shared decision-making issues; 2) most ethics consultations occur while patients are in the intensive care unit; and 3) earlier ethics consultations are likely to be for shared decision-making issues.
authors: Department of Surgery, Emory University, Atlanta, Georgia, USA. laurasjohnson@alumni.usc.edu
authors: Laura S
authors: LS
authors: Johnson
authors: Jason
authors: J
authors: Lesandrini
authors: Grace S
authors: GS
authors: Rozycki
mesh_terms: D000328:Adult; D000368:Aged; D003219:Confidentiality / Q000941:ethics; D003657:Decision Making / Q000941:ethics*; D033061:Ethics Consultation / Q000706:statistics & numerical data; D005260:Female; D005845:Georgia; D006801:Humans; D007362:Intensive Care Units / Q000941:ethics; D008297:Male; D008875:Middle Aged; D005791:Patient Care / Q000941:ethics*; D010358:Patient Participation; D040841:Resource Allocation / Q000941:ethics; D012189:Retrospective Studies; D013727:Terminal Care / Q000941:ethics; D014193:Trauma Centers / Q000941:ethics*