Ethics Consultation in U.S. Hospitals: A National Follow-Up Study

Abstract

A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC.

Keywords:

• Clinical ethics
• empirical research
• ethicist
• ethics committee
• health care ethics
• survey

This article is referred to by:

The Good, the Bad, and the Inconvenient

Mitigating Moral Distress through Ethics Consultation

A Call for Evidence-Based Clinical Ethics Consultation

View Across the Pond: Insights from a National Survey on Clinical Ethics Services in Switzerland

Quality Healthcare Ethics Consultation: How Do We Get It and How Do We Measure It

Ethics Consultant Training Standards: Don't Lower the Bar Without Benefit

A Hub and Spoke Model for Improving Access and Standardizing Ethics Consultations Across a Large Healthcare System

The ASBH’s Obligation to Create Cost-Free Basic HEC Training

Incorporating Ethics Consultations into Public Health Practice

Assistant Coach, Advice Columnist, or Seasoned Diplomat: Distinguishing Between Formal, Informal, and “FYI” Ethics Consultations

It’s About Heterogeneity! Strategies to Advance the Evaluation of Ethics Consultation

ACKNOWLEDGMENTS

The authors would like to thank the following Altarum employees for their help on this work: Gillian Beach, Gregory Becker, Cydny Black, Elizabeth Blair, Erin Butto, Danisha Herrod, Jim Lee, Christine Stanik. We would also like to thank Paula Goodman-Crews and Alexander Kon for their valuable contributions to the expert panel, and Lisa Lehmann for her early involvement in the project. Finally, we would like to thank the hundreds of individuals and hospitals that participated in cognitive interviewing, pilot testing, or the survey study.

DISCLAIMER

The views expressed here are those of the authors and are not necessarily a reflection of the policies of their employers.

Notes

1 To determine the number of hospitals sampled in each bed-size category in the AHA database, we multiplied the fraction of total beds in that category (number of beds in category/number of beds in all U.S. general hospitals) by 600 (number of hospitals in the sample).

2 Major teaching hospitals are those with a Council of Teaching Hospitals designation. Minor teaching hospitals have one or more Accreditation Council for Graduate Medical Education accredited programs, have a medical school affiliation reported to the American Medical Association, and/or have an internship or residency approved by the American Osteopathic Association.

3 A rural hospital is located outside a Metropolitan Statistical Area, as designated by the U.S. Office of Management and Budget.

4 Range reflects means across the relevant bed size categories.

Additional information

Funding

This work was supported by the Greenwall Foundation under a Making a Difference Grant and a President’s Award. Marion Danis’s salary was supported by the Department of Bioethics, a part of the intramural program at the National Institutes of Health.