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A Team-Based Early Action Protocol to Address Ethical Concerns in the Intensive Care Unit. | LitMetric

A Team-Based Early Action Protocol to Address Ethical Concerns in the Intensive Care Unit.

Am J Crit Care

Patricia Jakel is a clinical nurse specialist, Santa Monica Hospital, University of California, Los Angeles, Health System, Los Angeles, California.

Published: January 2020

AI Article Synopsis

Article Abstract

Background: Ethical conflicts complicate clinical practice and often compromise communication and teamwork among patients, families, and clinicians. As ethical conflicts escalate, patient and family distress and dissatisfaction with care increase and trust in clinicians erodes, reducing care quality and patient safety.

Objective: To investigate the effectiveness of a proactive, team-based ethics protocol used routinely to discuss ethics-related concerns, goals of care, and additional supports for patients and families.

Methods: In a pre-post intervention study in 6 intensive care units (ICUs) at 3 academic medical centers, the electronic medical records of 1649 patients representing 1712 ICU admissions were studied. Number and timing of family conferences, code discussions with the patient or surrogate, and ethics consultations; palliative care, social work, and chaplain referrals; and ICU length of stay were measured. Preintervention outcomes were compared with outcomes 3 and 6 months after the intervention via multivariate logistic regression controlled for patient variables.

Results: The odds of receiving a family conference and a chaplain visit were significantly higher after the intervention than at baseline. The number of palliative care consultations and code discussions increased slightly at 3 and 6 months. Social work consultations increased only at 6 months. Ethics consultations increased at both postintervention time points. Length of ICU stay did not change.

Conclusions: When health care teams were encouraged to communicate routinely about goals of care, more patients received needed support and communication barriers were reduced.

Download full-text PDF

Source
http://dx.doi.org/10.4037/ajcc2020915DOI Listing

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