It has long been believed that earlier detection of cases for which the medical team and/or family eventually seek ethics consultation would improve patient care and staff well-being. However, to date little empirical data has been presented that quantifies the type and extent of the harms of delayed ethics consult requests. Here we report outcomes from analysis of a data set consisting of 1,700 ethics consults performed at a 923-bed academic medical center in the past 30 months. It will be shown that as the number of days between admission and the consult request increases, the complexity of the consultation, the level of conflict or disagreement, and the length of stay all increase in measurable and statistically significant ways. Notably, the type of ethics intervention needed transitions from focusing on values clarification or integration to managing conflict or disagreement, and physicians’ and nurses’ respective experience of patient care diverges, leaving nurses dealing with significantly more conflict and moral distress. By extension of this reasoning, hospital units that consult ethics more frequently would be expected to have lower consult complexity, lower rates of conflict, a more unified team experience in the provision of care, and fewer inappropriately long lengths of stay. Empirical evidence supporting each of these conclusions will be presented, as will our methods of monitoring these variables, strategies to identify root causes and advice on how we tell these stories with data through visualizations and information graphics, enhancing comprehension of this important element to building a moral community.
Kelly Armstrong – Director, Center for Clinical and Organizational Ethics, Inova Fairfax Medical Campus
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