Ethics Consultation in the Emergency Department
JONA?s Healthcare Law, Ethics, and Regulation 2007 January-March; 9(1): 32-35
Clinical ethics teams exist in various forms and have assisted care providers for several decades. Our clinical ethics service at an urban, tertiary, teaching hospital provides ethics consultation to care providers, patients, and their family members. Scenarios prompting an ethics consultation may be complex, often involving social, cultural, and fiscal components. Because patients who receive an ethics consultation often require a lengthy hospital stay, our group searched for unique identifiers in a patient's presentation to facilitate earlier and, potentially, more effective interventions. Of particular interest to our group was the presentation of these patients to our institution from the emergency department (ED). Our group's subjective experience indicated that factors requiring ethics consultation were often present very early during hospitalization. A retrospective medical record review of a convenience sample of 50 records of patients who had received a formal clinical ethics consult within a 14-month timeframe was done. Those patients who were admitted to the hospital via the ED and subsequently received an ethics consultation were identified. The critical issues prompting the ethics consult were then evaluated. Eighteen (35%) of the study patients were originally admitted through the ED. Results showed that the ethical issue(s) that prompted the clinical ethics consult was regularly identifiable in the ED. Our study results indicate that issues prompting ethics consults may potentially be identified as patients present to the ED. Rapid and effective interventions proscribed through institutional policy guidelines could greatly assist nurses and other ED providers in identifying these at-risk patients upon entry of the ED. Such a policy would ultimately benefit both patient and provider.
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