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Evaluating the Inpatient Pediatric Ethical Consultation Service.

Kelsey Watt1,2, Matthew P Kirschen3,4,5, Joel A Friedlander6,7,8,9

  • 1Children's Hospital Colorado, Aurora, Colorado.

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Pediatric ethical consultation services are underused, especially for issues causing staff moral distress. This study found formal consultations are infrequent despite frequent ethical challenges in pediatric care.

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Area of Science:

  • Medical Ethics
  • Pediatric Healthcare Delivery
  • Hospital Administration

Background:

  • Pediatric ethical consultation services (ECSs) are increasingly common in medical centers.
  • There is limited data available on the implementation and effectiveness of these services.
  • Evaluating pediatric ECSs is crucial for understanding their role in addressing ethical issues.

Purpose of the Study:

  • To evaluate the pediatric ethical consultation service (ECS) at a quaternary-level pediatric hospital.
  • To identify and understand the types of ethical issues encountered by healthcare staff.
  • To assess the utilization of formal ECSs in relation to staff-reported ethical concerns.

Main Methods:

  • Retrospective chart review of documented ethics consultations (November 2010-November 2013).
  • Prospective electronic survey distributed to inpatient staff regarding encountered ethical issues (November 2013-January 2014).
  • Data abstraction using the US Department of Veterans Affairs' Domains of Ethics in Health Care framework.

Main Results:

  • 47 ethics consults were documented, primarily concerning end-of-life care and shared decision-making.
  • 63 staff members reported ethical issues, but only 5 formal consults occurred during the survey period.
  • Common ethical domains included end-of-life care, shared decision-making, and everyday workplace issues; 81% of staff reported distress.

Conclusions:

  • Formal pediatric ethical consultation services (ECSs) are underutilized in this single-center study.
  • ECSs are particularly underused for ethical domains that lead to significant staff moral distress.
  • Further research is needed to optimize ECS implementation and utilization in pediatric settings.