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

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A proactive ethics protocol improved patient support and communication in intensive care units (ICUs). This team-based approach increased family conferences and chaplain visits, reducing ethical conflicts and enhancing care quality.

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Area of Science:

  • Medical Ethics
  • Healthcare Management
  • Clinical Communication

Background:

  • Ethical conflicts in clinical practice negatively impact patient-family-clinician communication and teamwork.
  • Escalating ethical conflicts lead to increased patient/family distress, dissatisfaction, and eroded trust, compromising care quality and safety.

Purpose of the Study:

  • To evaluate the effectiveness of a proactive, team-based ethics protocol for routine discussions on ethics-related concerns and goals of care.
  • To assess the protocol's impact on patient and family support within intensive care units (ICUs).

Main Methods:

  • A pre-post intervention study was conducted across 6 ICUs in 3 academic medical centers.
  • Data from 1649 patients (1712 ICU admissions) were analyzed, measuring family conferences, code discussions, ethics consultations, palliative care, social work, and chaplain referrals.
  • Outcomes were compared pre- and post-intervention (3 and 6 months) using multivariate logistic regression.

Main Results:

  • The intervention significantly increased the likelihood of family conferences and chaplain visits.
  • Palliative care and code discussions showed slight increases at 3 and 6 months post-intervention.
  • Ethics consultations increased at both post-intervention time points, while social work consultations increased at 6 months. ICU length of stay remained unchanged.

Conclusions:

  • Encouraging routine communication about goals of care among healthcare teams led to increased patient support.
  • The team-based ethics protocol effectively reduced communication barriers and improved access to supportive services for patients and families.