title: Developing and testing a checklist to enhance quality in clinical ethics consultation.
abstract: Checklists have been used to improve quality in many industries, including healthcare. The use of checklists, however, has not been extensively evaluated in clinical ethics consultation. This article seeks to fill this gap by exploring the efficacy of using a checklist in ethics consultation, as tested by an empirical investigation of the use of the checklist at a large academic medical system (Cleveland Clinic). The specific aims of this project are as follows: (1) to improve the quality of ethics consultations by providing reminders to ethics consultants about process steps that are important for most patient-centered ethics consultations, (2) to create consistency in the ethics consultation process across the medical system, and (3) to establish an effective educational tool for trainers and trainees in clinical ethics consultation. The checklist was developed after a thorough literature review and an iterative process of revising and testing by a group of experienced ethics consultants. To pilot test the checklist, it was distributed to 46 ethics consultants. After a six-month pilot period in which ethics professionals used the checklist during their clinical activities, a survey was distributed to all of those who used the checklist. The 10-item survey examined consultants' perceptions regarding the three aims listed above. Of the 25 survey respondents, 11 self-reported as experts in ethics consultation, nine perceived themselves to have mid-level expertise, and five self-reported as novices. The majority (68 percent) of all respondents, regardless of expertise, believed that the checklist could be a "helpful" or "very helpful" tool in the consultation process generally. Novices were more likely than experts to believe that the checklist would be useful in conducting consultations. The limitations of this study include: reduced generalizability given that this project was conducted at one medical system, utilized a small sample size, and used self-reported quality outcome measures. Despite these limitations, to the authors' knowledge this is the first investigation of the use of a checklist systematically to improve quality in ethics consultation. Importantly, our findings shed light on ways this checklist can be used to improve ethics consultation, including its use as an educational tool. The authors hope to test the checklist with consultants in other healthcare systems to explore its usefulness in different healthcare environments.
authors.affiliation: Montefiore Einstein Center for Bioethics, Montefiore Medical Center, New York, NY USA.
authors.forename: Lauren Sydney
authors.initials: LS
authors.lastname: Flicker
authors.affiliation: Cleveland Clinic Department of Bioethics, 9500 Euclid Avenue, JJ60, Cleveland, OH 44195 USA. roses2@CCF.org.
authors.forename: Susannah L
authors.initials: SL
authors.lastname: Rose
authors.affiliation: Cleveland Clinic Department of Bioethics, 9500 Euclid Avenue, JJ60, Cleveland, OH 44195 USA.
authors.forename: Margo M
authors.initials: MM
authors.lastname: Eves
authors.affiliation: Cleveland Clinic Department of Bioethics, 9500 Euclid Avenue, JJ60, Cleveland, OH 44195 USA.
authors.forename: Anne Lederman
authors.initials: AL
authors.lastname: Flamm
authors.affiliation: Cleveland Clinic Department of Bioethics, 9500 Euclid Avenue, JJ60, Cleveland, OH 44195 USA.
authors.forename: Ruchi
authors.initials: R
authors.lastname: Sanghani
authors.affiliation: Cleveland Clinic Department of Bioethics, 9500 Euclid Avenue, JJ60, Cleveland, OH 44195 USA.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Smith
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D057189:Checklist / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D026822:Ethicists / Q000193:education / Q000592:standards; D033061:Ethics Consultation / Q000592:standards / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D018802:Patient-Centered Care / Q000941:ethics / Q000592:standards / Q000639:trends; D011787:Quality of Health Care / Q000592:standards / Q000639:trends; D015203:Reproducibility of Results; D012107:Research Design; D018401:Sample Size; D057566:Self Report; D011795:Surveys and Questionnaires