Rafting the ethical rapids

Outcomes of Ethics Consultations in Adult ICUs: A Systematic Review and Meta-Analysis

OBJECTIVES

Clinical ethics consultation as a mechanism for supporting patients, family, and staff during ethically challenging situations has become standard of care. Despite this, there is a lack of consensus about the effectiveness of clinical ethics consultation consultation in the ICU. We performed a systematic review of outcomes associated with clinical ethics consultation within adult ICUs.

DATA SOURCES

We searched MEDLINE, PubMed, Cochrane CENTRAL, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature from 1984 to May 2017.

STUDY SELECTION

Two reviewers independently screened articles, assessed eligibility, extracted data, and assessed risk of bias using the Cochrane Collaboration Risk of Bias tool and the Newcastle-Ottawa Scale. Pooled estimates of effect were calculated where possible. We screened 3,970 abstracts and reviewed 325 full-text articles of which 16 met all eligibility criteria.

DATA EXTRACTION

We examined changes in processes and outcomes as a result of clinical ethics consultation in the ICU. Categories of outcomes included user perception, clinical decision, or conflict resolution and resource utilization.

DATA SYNTHESIS

The use of clinical ethics consultation in the ICU was associated with positive user experience (383/435 found clinical ethics consultation helpful), although stress and disagreement with clinical ethics consultation recommendations was greater in a subset (113/431 surrogates and providers). Consensus for a clinical decision was more frequently achieved with clinical ethics consultation (odds ratio, 4.09; 95% CI, 1.01-16.55; p = 0.05). Clinical ethics consultation was associated with lower resource utilization including significantly decreased ICU length of stay (mean difference, -4.65 d; 95% CI, -8.86 to -0.44; p = 0.03).

CONCLUSIONS

Our review identified outcome-based assessment as the predominant measure used to report effectiveness of clinical ethics consultation consultations. In particular, clinical ethics consultation decreased ICU length of stay and increased family and healthcare provider satisfaction. However, using outcome measures as the primary endpoint may not reflect the original intent of the clinical ethics consultation service. Based on our review, we propose a list of process measures that may better capture the key domains of a quality clinical ethics consultation.

What is to be expected from an ethics audit integrated within the accreditation process of hospitals from romania?

BACKGROUND

We aimed to verify the issue of the ethics audit and its use in the system of accreditation of hospitals. It presents the results of a survey conducted among hospital managers from Romania.

METHODS

Our article highlights the results of the second part of a research carried out in 2012 on the pertinence and the structure of the ethics audit integrated within the accreditation process of hospitals, according the opinion of the 47 executives and managers involved in the quality management of Romania hospitals. The data have been gathered with the aid of the online questionnaire.

RESULTS

An ethics audit integrated within the accreditation process of hospitals should include primarily the respect of the patients' rights, the good relations of the institutions with its patients and the respect of the moral rights of the employees.

CONCLUSION

The usefulness of this study is due to the fact that it consults precisely those who should really contribute to the creation, application and monitoring of ethical policies and instruments necessary in every hospital which are permanently under the scrutiny of public opinion and confront themselves with the obligation to give a thorough account of their results and spending of the public resources. This study gain consistency as the relevant aspects that could form the structure of a hospital ethics audit are identified with the direct help of the managers responsible for implementing it.