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

Elizabeth G. Nilson, Cathleen A. Acres, Naomi G. Tamerin, Joseph Fins

Research output: Contribution to journalArticle

28 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)356-364
Number of pages9
JournalAmerican Journal of Medical Quality
Volume23
Issue number5
DOIs
StatePublished - Sep 1 2008

Keywords

  • Clinical ethics consultation
  • Empirical study
  • End-of-life care
  • Quality of care

ASJC Scopus subject areas

  • Health Policy
  • Nursing(all)

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