1
|
Weaver MS, Wichman C, Sharma S, Walter JK. Demand and Supply: Association between Pediatric Ethics Consultation Volume and Protected Time for Ethics Work. AJOB Empir Bioeth 2022; 14:135-142. [PMID: 36574230 DOI: 10.1080/23294515.2022.2160512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Despite national increase in pediatric ethics consultation volume over the past decade, protected time and resources for healthcare ethics consultancy work has lagged. METHODS Correlation study investigating potential associations between ethics consult volume reported by recent national survey of consultants at children's hospitals and five programmatic domains. RESULTS 104 children's hospitals in 45 states plus Washington DC were included. There was not a statistically significant association between pediatric ethics consult volume and hospital size, rurality of patient population, or number of consultants. Academically-affiliated children's hospitals had fewer ethics consults compared to nonacademically affiliated. Association was found between full-time equivalent (FTE) hours and number of ethics consults (p < 0.0001). Spearman rank correlation between ethics consult volume and FTE was 0.5. CONCLUSIONS While the results of this study should be interpreted with caution, investment in protected time for ethics consultancy work may translate into increased volume of pediatric ethics consults.
Collapse
Affiliation(s)
- Meaghann S Weaver
- Department of Pediatrics, Pediatric Palliative Care, University of Nebraska Medical Center, Omaha, NE, USA
- Veterans Health Affairs, National Center for Ethics in Healthcare, Washington, DC, USA
| | - Christopher Wichman
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shiven Sharma
- Department of Medical Ethics and Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer K Walter
- Department of Medical Ethics and Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
2
|
Danis M, Fox E, Tarzian A, Duke CC. Health care ethics programs in U.S. Hospitals: results from a National Survey. BMC Med Ethics 2021; 22:107. [PMID: 34325688 PMCID: PMC8320092 DOI: 10.1186/s12910-021-00673-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/14/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND As hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking. METHODS Based on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs. RESULTS Among 372 hospitals whose informants responded to an online survey, 97% of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents' strategies for managing challenges include staff training and additional funds. CONCLUSIONS While this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs.
Collapse
Affiliation(s)
- Marion Danis
- Department of Bioethics, National Institutes of Health, Building 10, Rm 1C118, Bethesda, MD, 20892-1156, USA.
| | - Ellen Fox
- Fox Ethics Consulting, Arlington, VA, 22213, USA
| | - Anita Tarzian
- National Center for Ethics in Health Care, Veterans Health Administration, 811 Vermont St. NW., Washington, DC, 20571, USA
| | | |
Collapse
|
3
|
Nortje N, Jones-Bonofiglio K, Haque S, Rathi N. Operational framework for rural hospitals during a pandemic. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2020.1870369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Nico Nortje
- Department of Critical care and Respiratory Care, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Dietetics, University of the Western Cape, Bellville, South Africa
- Lakehead University Centre for Health Care Ethics, Thunder Bay, Ontario, Canada
| | - Kristen Jones-Bonofiglio
- Lakehead University Centre for Health Care Ethics, Thunder Bay, Ontario, Canada
- International Network of the UNESCO Chair in Bioethics, Haifa, Israel
| | - Sajid Haque
- Department of Critical care and Respiratory Care, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nisha Rathi
- Department of Critical care and Respiratory Care, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
4
|
Patel L, Elliott A, Storlie E, Kethireddy R, Goodman K, Dickey W. Ethical and Legal Challenges During the COVID-19 Pandemic: Are We Thinking About Rural Hospitals? J Rural Health 2020; 37:175-178. [PMID: 32282953 PMCID: PMC7262323 DOI: 10.1111/jrh.12447] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Love Patel
- Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Amy Elliott
- Allina Faribault Hospital and Clinic, Faribault, Minnesota
| | - Erik Storlie
- Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Rajesh Kethireddy
- Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Kim Goodman
- Clinical Ethics and Value Program, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - William Dickey
- Interim Vice President, Medical Affairs, Abbott Northwestern Hospital, Minneapolis, Minnesota
| |
Collapse
|
5
|
de Brito GMG, de Oliveira Santa Rosa D. Nurses performance in clinical ethics committees and commissions: An integrative review. Nurs Ethics 2017; 26:688-699. [PMID: 28933257 DOI: 10.1177/0969733017724611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The research on nursing professionals in Clinical Ethics Committees and Nursing Ethics Commissions occurs in different parts of the world; however, little information on this subject is found in the literature. OBJECTIVE This study analyzed national and international publications in relation to the participation of nursing professionals in Clinical Ethics Committees. RESEARCH DESIGN This was an integrative review of articles published in national and international journals between 1994 and 2016 which described the participation of nursing professionals in ethics commissions. PARTICIPANTS AND RESEARCH CONTEXT A total of 35 articles were selected. DISCUSSION AND CONCLUSION FOR THIS ARTICLE The thematic categories were the need for time to discuss ethical issues; ethics committee to reduce the moral suffering of professionals; competencies required for participation; and barriers/difficulties and facilitators for implementation/ performance. It was concluded that professionals recognize the need for ethics committees to foster discussions. However, barriers hamper operation and fundamental competencies for participation. Communication of committee activities to professionals and educational activities may be major allies to improve the functioning of these committees.
Collapse
|
6
|
Morrison W, Womer J, Nathanson P, Kersun L, Hester DM, Walsh C, Feudtner C. Pediatricians' Experience with Clinical Ethics Consultation: A National Survey. J Pediatr 2015. [PMID: 26210945 DOI: 10.1016/j.jpeds.2015.06.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To conduct a national survey of pediatricians' access to and experience with clinical ethics consultation. STUDY DESIGN We surveyed a randomly selected sample of 3687 physician members of the American Academy of Pediatrics. We asked about their experiences with ethics consultation, the helpfulness of and barriers to consultation, and ethics education. Using a discrete choice experiment with maximum difference scaling, we evaluated which traits of ethics consultants were most valuable. RESULTS Of the total sample of 3687 physicians, 659 (18%) responded to the survey. One-third of the respondents had no experience with clinical ethics consultation, and 16% reported no access to consultation. General pediatricians were less likely to have access. The vast majority (90%) who had experience with consultation had found it helpful. Those with fewer years in practice were more likely to have training in ethics. The most frequently reported issues leading to consultation concerned end-of-life care and conflicts with patients/families or among the team. Intensive care unit physicians were more likely to have requested consultation. Mediation skills and ethics knowledge were the most highly valued consultant characteristics, and representing the official position of the hospital was the least-valued characteristic. CONCLUSION There is variability in pediatricians' access to ethics consultation. Most respondents reported that consultation had been helpful in the past. Determining ethically appropriate end-of-life care and mediation of disagreements are common reasons that pediatricians request consultation.
Collapse
Affiliation(s)
- Wynne Morrison
- Pediatric Advanced Care Team, Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - James Womer
- Pediatric Advanced Care Team, Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, PA; Temple University School of Medicine, Philadelphia, PA
| | - Pamela Nathanson
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Leslie Kersun
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - D Micah Hester
- Division of Medical Humanities, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Corbett Walsh
- New York University School of Medicine, New York, NY
| | - Chris Feudtner
- Pediatric Advanced Care Team, Department of Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
7
|
Nelson WA, Barr PJ, Castaldo MG. The opportunities and challenges for shared decision-making in the rural United States. HEC Forum 2015; 27:157-70. [PMID: 26013844 DOI: 10.1007/s10730-015-9283-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The ethical standard for informed consent is fostered within a shared decision-making (SDM) process. SDM has become a recognized and needed approach in health care decision-making. Based on an ethical foundation, the approach fosters the active engagement of patients, where the clinician presents evidence-based treatment information and options and openly elicits the patient's values and preferences. The SDM process is affected by the context in which the information exchange occurs. Rural settings are one context that impacts the delivery of health care and SDM. Rural health care is significantly influenced by economic, geographical and social characteristics. Several specific distinctive features influence rural health care decision-making-poverty, access to health care, isolation, over-lapping relationships, and a shared culture. The rural context creates challenges as well as fosters opportunities for the application of SDM as a natural dynamic within the rural provider-patient relationship. To fulfill the ethical requirements of informed consent through SDM, it is necessary to understand its inherent challenges and opportunities. Therefore, rural clinicians and ethicists need to be cognizant of the impact of the rural setting on SDM and use the insights as an opportunity to achieve SDM.
Collapse
Affiliation(s)
- William A Nelson
- Psychiatry, Community and Family Medicine, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA,
| | | | | |
Collapse
|
8
|
Lee DC, Carr BG, Smith TE, Tran VC, Polsky D, Branas CC. The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis. Popul Health Manag 2015; 18:459-66. [PMID: 25658768 DOI: 10.1089/pop.2014.0123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Emergency visits are rising nationally, whereas the number of emergency departments is shrinking. However, volume has not increased uniformly at all emergency departments. It is unclear what factors account for this variability in emergency volume growth rates. The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. The study team analyzed emergency department volume at New York State hospitals from 2004 to 2010 using data from cost reports and administrative databases. Multivariate regression was used to evaluate characteristics associated with emergency volume growth. Spatial analytics and distances between hospitals were used in calculating the predicted impact of hospital closures on emergency department use. Among the 192 New York hospitals open from 2004 to 2010, the mean annual increase in emergency department visits was 2.7%, but the range was wide (-5.5% to 11.3%). Emergency volume increased nearly twice as fast at tertiary referral centers (4.8%) and nonurban hospitals (3.7% versus urban at 2.1%) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth. Emergency volume is increasing faster at specific hospitals: tertiary referral centers, nonurban hospitals, and those near hospital closures. This study provides an understanding of how emergency volume varies among hospitals and predicts the effect of hospital closures in a statewide region. Understanding the impact of these factors on emergency department use is essential to ensure that these populations have access to critical emergency services.
Collapse
Affiliation(s)
- David C Lee
- 1 Department of Emergency Medicine, New York University School of Medicine , New York, New York
- 2 Department of Population Health, New York University School of Medicine , New York, New York
- 3 Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania , Philadelphia, Pennsylvania
- 4 Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Brendan G Carr
- 5 Department of Emergency Medicine, Kimmel School of Medicine, Thomas Jefferson University , Philadelphia, Pennsylvania
- 6 Emergency Care Coordination Center , Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC
| | - Tony E Smith
- 7 Department of Electrical and Systems Engineering, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Van C Tran
- 8 Department of Sociology, Columbia University , New York, New York
| | - Daniel Polsky
- 4 Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, Pennsylvania
- 9 Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
- 10 Department of Health Care Management, The Wharton School, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Charles C Branas
- 4 Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia, Pennsylvania
- 11 Department of Biostatistics and Epidemiology, University of Pennsylvania , Philadelphia, Pennsylvania
- 12 Cartographic Modeling Laboratory, University of Pennsylvania , Philadelphia, Pennsylvania
| |
Collapse
|
9
|
Geppert CMA, Shelton WN. A comparison of general medical and clinical ethics consultations: what can we learn from each other? Mayo Clin Proc 2012; 87:381-9. [PMID: 22469350 PMCID: PMC3538413 DOI: 10.1016/j.mayocp.2011.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 10/05/2011] [Accepted: 10/07/2011] [Indexed: 11/25/2022]
Abstract
Despite the emergence of clinical ethics consultation as a clinical service in recent years, little is known about how clinical ethics consultation differs from, or is the same as, other medical consultations. A critical assessment of the similarities and differences between these 2 types of consultations is important to help the medical community appreciate ethics consultation as a vital service in today's health care setting. Therefore, this Special Article presents a comparison of medical and clinical ethics consultations in terms of fundamental goals of consultation, roles of consultants, and methodologic approaches to consultation, concluding with reflections on important lessons about the physician-patient relationship and medical education that may benefit practicing internists. Our aim is to examine ethics consultation as a clinical service integral to the medical care of patients. Studies for this analysis were obtained through the PubMed database using the keywords ethics consultation, medical consultation, ethics consults, medical consults, ethics consultants, and medical consultants. All English-language articles published from 1970 through August 2011 that pertained to the structure and process of medical and ethics consultation were reviewed.
Collapse
Affiliation(s)
- Cynthia M A Geppert
- New Mexico Veterans Affairs Health Care System and Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, USA
| | | |
Collapse
|