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Clinical Ethics and the Quality Initiative: A Pilot Study for the Empirical Evaluation of Ethics Case Consultation

Division of Medical Ethics, Weill Medical College of Cornell University, New York, eln2004{at}med.cornell.edu

Cathleen A. Acres, RN, MA

Division of Medical Ethics, Weill Medical College of Cornell University, New York

Naomi G. Tamerin, MD

New York-Presbyterian Healthcare System

Joseph J. Fins, MD

Division of Medical Ethics, Weill Medical College of Cornell University, New York

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. (Am J Med Qual 2008;23:356-364)

Key Words: clinical ethics consultation • quality of care • end-of-life care • empirical study

American Journal of Medical Quality, Vol. 23, No. 5, 356-364 (2008)
DOI: 10.1177/1062860608316729


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