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building an ethics service | components

building an ethics service | components. | new questions and models | physician capacity | empirically driven. “To educate and hope is a futile strategy.” - Jack Glaser. systems | a different dilemma. capacity | mentors and aces. | Relationship. | Culture. | Meaning.

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building an ethics service | components

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  1. building an ethics service |components | new questions and models | physician capacity | empirically driven

  2. “To educate and hope is a futile strategy.” - Jack Glaser

  3. systems| a different dilemma

  4. capacity| mentors and aces

  5. | Relationship | Culture | Meaning

  6. spread|early adopters

  7. Engaging Physicians • Education • Integration

  8. Medical Resident Roundtables • Bioethics Grand Rounds • Bioethics focused CME • Mandatory ethics conferences (ICU)

  9. Building an Ethics Service |metrics

  10. Context for Ethics Consultation • Columbia St. Mary’s Health System • Four Acute Care Hospitals ~700 beds • 35+ physician clinics with ~240 employed physicians • FY 2008: 342,182 outpatient visits; 69,346 ED visits; 25,891 inpatient admissions • Ethics Consultation Service: • Two Medical Staff Ethics Committees • One PhD Ethicist; Ad Hoc Consultation Model/Advisement Model • Advisement: ERD Clarification; Ethics Policy Elaboration; family care conference attendance • Consultation: all non-advisement matters • Ethics Consultation for Database: • 278 consults from January 2003 through December 2008 • Cases: • Identified ethical reason for consultation • Identified discipline requesting • CSM Ethics consultation service engaged • Ethics consultation documented • Ethics recommendations made to case

  11. Ethics Consultation Intake: Requestor Info

  12. Clinical Ethics Consultation: Columbia St. Mary’s Health System • CSM Ethics Consultation for Database: • 278; January 2003 - September 2008 No. of Consults/Literature: 255; Swetz, et al. Mayo Clinic Proceedings 2007; 82(6): 686-691. 150; Schenkenberg. HEC Forum 1997; 9;147-158. 104; La Puma, et al. JAMA 1988;260: 808-811. 31; Forde & Vandvik. J Med Ethics. 2005; 31:73-77. 39; Waisel, et al. Mil Med 2000; 165:528-532.

  13. Clinical Ethics Consultation:Quantitative Measures of Ethics IntegrationMean Days Consult from DoA

  14. Clinical Consultation Changing Organizational Practice • Ethics Tracker Database • August 2006-October 2006 • 3 consults related to Intra/peri-operative Code Status • Physician Association Guidelines • American College of Surgeons: ST-19 Statement on Advance Directive by Patients: “Do Not Resuscitate” in the Operating Room • American Society of Anesthesiologists: Ethical Guidelines for the Anesthesia Care of Patients with Do-Not-Resuscitate Orders • Goal: Initiate opportunity within existing pre-precedure processes for MD to address with patient or designated surrogate(s) existing directives to limit the use of resuscitation procedures • Dept of Surgery follow-up re: Ethics Case Consultations • Grand Rounds follow-up with CME Accountabilities for CIP

  15. Clinical Consultation Changing Organizational Practice • Medical Staff Pre- Procedure Checklist Adopted: • Dept Anesthesiology • Dept Surgery • Dept Orthopedic Surgery • Dept of Medicine (Exec Council)

  16. actionpoints

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