Universal Ethics Evaluation of ICU Patients: A Model.
Background: Clinical ethics consultations are typically provided on a reactive basis and in response to ethical dilemmas or crises. Proactive clinical ethics might be preventative; however proactive ethics has primarily been demonstrated in academic settings with specific patient groups. We propose...
| Publicado en: | Journal of Hospital Ethics Vol. 8; no. 3; pp. 64 - 72 |
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| Autores principales: | , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
MedStar Washington Hospital Center, Center for Ethics
Oct2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=159836608&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 159836608 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 19384955 FNKI jtl: Journal of Hospital Ethics issn: 19384955 maglogo: N pubinfo: dt: Oct2022 vid: 8 iid: 3 pid: 82867 pub: MedStar Washington Hospital Center, Center for Ethics place: Washington, District of Columbia artinfo: ui: 159836608 159836608 159836608 159836608 ppf: 64 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Universal Ethics Evaluation of ICU Patients: A Model. aug: au: Mayer, Patricia A. McElfresh, Duncan C. Bracamontes, Katherine sug: subj: World Health Ethical Issues Intensive Care Units Ethical Issues Critically Ill Patients Ethical Issues Ethics, Medical Evaluation Critical Care Ethical Issues Human Male Female Adolescence Young Adult Adult Middle Age Aged Aged, 80 and Over Pilot Studies Ethicists Inpatients Funding Source Resuscitation Orders Durable Power of Attorney Advance Care Planning Patient Preference Conflict (Psychology) Retrospective Design Costs and Cost Analysis Hospitalization Outcomes (Health Care) Record Review Goals and Objectives Risk Assessment Prevalence Resuscitation, Cardiopulmonary Descriptive Statistics Logistic Regression Odds Ratio Pearson's Correlation Coefficient Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: Background: Clinical ethics consultations are typically provided on a reactive basis and in response to ethical dilemmas or crises. Proactive clinical ethics might be preventative; however proactive ethics has primarily been demonstrated in academic settings with specific patient groups. We propose an approach in which every patient in the intensive care unit is screened for specific, actionable ethics-related criteria. Methods: Our methods were developed during a one-year pilot in which a clinical ethicist was embedded in an ICU. The ethicist evaluated as many patients as possible with no explicit selection criteria; three hundred and seventy-three patients were evaluated (39% of all admitted patients). The ethicist used four ethics-related criteria to assess patients for potentially problematic ethical issues: (a) Code Status, (b) presence/absence of Medical Power of Attorney or correctly identified Surrogate Decision Maker (c) presence/absence of Goals/Plan of Care consistent with patient wishes, and (d) presence/absence of Conflict. The time spent by the ethicist was recorded for each patient, and financial impact was evaluated separately by the institution. We retrospectively analyze these ethics-related criteria in conjunction with patient outcomes for the hospitalization. Results and Conclusions: Over two-thirds of the patients had problematic findings on initial evaluation in at least one of the four ethics criteria; 20% had no Code Status selected, 57% had no MPOA or surrogate, 49% had no clear Goals/Plan of Care and 25% had Conflict present. Of the 80% of patients with an initial Code Status, 25% were changed during the hospitalization. 22 % of the patients screened needed no ethics intervention/support, 47% received intermediate support, and 31% required extensive ethics support. Each of the four ethics-related criteria was associated with a greater need for ethics support, and each can be quickly assessed. We hope that our methods will inspire other innovations in clinical ethics consultation services. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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