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Data Collection & Ethics Consultations: Beyond Quality Improvement and Futility Studies

June 17, 2016

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Ethics consultations are universally recognized as a necessary component in healthcare, often recommended by regulatory agencies such as the Joint Commission on Accreditation of Healthcare Organizations. For Catholic healthcare, which must attend to the Ethical and Religious Directives for Catholic Healthcare Services (ERDs), an explicit instruction is that “[a]n ethics committee or some alternate form of ethical consultation should be available to assist by advising on particular ethical situations.” While much of modern day bioethics finds its source in Catholic Church theologians and philosophers, Catholic healthcare has “remained relatively absent from these more recent discussions in the bioethics literature.” Mercy West Communities has begun development of a new model that includes development of a tool intended to gather qualitative and quantitative data as well as employing full-time ethicists in the hub hospitals in each community. Over the past four years, Homan has developed the proprietary instrument Ethics Consultation Worksheet (ECW) to document ethics consultation as well as capture relevant, qualitative information related to the ethics consultation. This tool utilizes a “best of breed” mentality. Development of the tool has included in-depth literature reviews across multiple fields of study and extensive input from internal and external stakeholders and experts representing numerous organizations. Data elements have been validated by Repenshek’s work which were based on the Veteran’s Health Administration IntegratedEthics® program as well as the American Society for Bioethics and the Humanities Core Competencies for CEC. This paper will first explore the significance of ethics consultation in healthcare. Subsequently, this paper will describe and critically review three previous studies that examined ethics consultations as a mechanism to avoid costs. Finally, we will discuss the Mercy West Communities approach to the ethics consultation service including a full-time ethicist with ethics responders initiative as well as the integration of EthicsTrackerTM (a Microsoft Access database created in 2006 by Harmony Technologies, LLC to track trends in the ethics consultation process), and the development of an economic evaluation model. This model relies on a cost-benefit analysis whereby we assume that the benefits of the ethics consultation service exceeds its costs and that there is a positive net social benefit of the service.

Keywords:
Clinical ethics; Case Studies; Technology in healthcare