SHM Converge Scientific Abstract ePoster Gallery-Characteristics and Outcomes of a Bedside Ethics Consult Service for Hospital Medicine Patients

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This study describes a bedside Ethics Consult Service for hospital medicine patients and examines the ethical issues, patient characteristics, and recommendations from consults between January and November 2021.<br /><br />The service received 48 ethics consults overall, 21 of which came from hospital medicine. Researchers reviewed these consult notes and used the Armstrong Clinical Ethics Consultation Coding System to identify ethical themes and categorize recommendations.<br /><br />Most patients were medically complex and lacked decision-making capacity: 86% lacked capacity and 14% had unclear capacity. About 71% had surrogate decision-makers, none had advance directives, and 25% were unrepresented. Palliative care had already been consulted in 76% of cases. Most consults came from the general medicine unit, and nearly all were requested by attending physicians or trainees. The median length of stay before the ethics consult was 31 days.<br /><br />The most common ethical issues involved substitute decision-making, including unclear patient wishes, concerns about the surrogate’s choices, determining the appropriate decision-maker, and the absence of a decision-maker. Other frequent issues included refusal of treatment and uncooperative behavior.<br /><br />The most common recommendation was to hold a family meeting (43%). Other recommendations included clarifying the patient’s wishes or goals, continuing life-sustaining treatment, improving communication, addressing discharge planning, and supporting surrogate decision-making.<br /><br />The authors conclude that ethics consults provide a distinct role even when palliative care is already involved. Because consults often occurred late in hospitalization and often involved discharge planning, earlier ethics involvement may help reduce length of stay and improve mediation with surrogates. They also suggest increasing awareness of the service among social workers, since they rarely initiated consults despite the frequency of unrepresented patients and discharge-related issues.

Asset Subtitle

Krishna A. Chokshi

Meta Tag

Author List Isabelle C. Band, Krishna A. Chokshi

Category Research

Concept Ethics Consultation

Concept Ethical Issue

Concept Substitute Decision-Making

Concept Unrepresented Patient

Concept Hospital Care

Distinguished Non-Finalist

Presenter Organization Icahn School of Mount Sinai

Presenting Author Krishna A. Chokshi

Track Quality Improvement

Keywords

ethics consult service

hospital medicine

decision-making capacity

surrogate decision-making

unrepresented patients

palliative care

family meeting

hospital ethics

discharge planning

clinical ethics consultation

Ethics Consultation

Ethical Issue

Substitute Decision-Making

Unrepresented Patient

Hospital Care