Ethics Consultation in U.S. Hospitals: Determinants of Consultation Volume

Abstract

The annual volume of ethics consultations (ECs) has been a topic of interest in the bioethics literature, in part because of its presumed relationship to quality. To better understand factors associated with EC volume, we used multiple linear regression to model the number of case consultations performed in the last year based on a national survey. We found that hospital bed size, academic affiliation, and urban/rural location were all associated with EC volume, but were not the primary drivers. Instead, these variables affected EC volume through three other variables, all of which relate to ethics staffing: the percentage of case consultations performed by a single individual; whether the survey respondent’s main role at the hospital contained the word “ethics”; and especially, the number of full-time ethics program staff. We conclude that EC is an example of supply-sensitive care, and further research is needed to determine the optimal level of EC activity.

Keywords:

• Clinical ethics
• empirical research
• ethicist
• ethics committee
• healthcare ethics
• regression
• survey

This article is referred to by:

A Call for Evidence-Based Clinical Ethics Consultation

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

Ethics Consultation Services as a Resource and its Implications for Evaluation Activities

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

Incorporating Ethics Consultations into Public Health Practice

Measuring Value with Volume

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.

Additional information

Funding

This work was supported by the Greenwall Foundation under a 2015 Making a Difference Grant and a 2018 President’s Award.