Clinical ethics and the quality initiative: a pilot study for the empirical evaluation of ethics case consultation

Am J Med Qual. 2008 Sep-Oct;23(5):356-64. doi: 10.1177/1062860608316729.

Abstract

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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Conflict, Psychological
  • Decision Making
  • Ethics Consultation / organization & administration*
  • Ethics, Clinical*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Quality of Health Care / organization & administration*
  • Resuscitation Orders / ethics
  • Terminal Care / ethics*
  • Time Factors