An Ethics Consult Documentation Simplification Project: Summation of Participatory Processes, User Perceptions, and...

Area of Science:

• Healthcare Ethics
• Health Informatics
• Quality Improvement

Background:

• The Veterans Health Administration (VHA) utilizes IEWeb, an enterprise-wide database, for healthcare ethics consult documentation across 1300 facilities.
• A need was identified to transition IEWeb from a training resource to an efficient documentation repository capturing essential consult elements.

Purpose of the Study:

• To enhance the IEWeb database for streamlined healthcare ethics documentation.
• To improve the efficiency, frequency, and quality of ethics consult documentation within the VHA.

Main Methods:

• Convening a VHA National Center for Ethics in Health Care (NCEHC) Improvement Team.
• Conducting six focus groups with users to specify and prioritize IEWeb changes.
• Implementing regional pilots and national surveys to measure impact and user perspectives.

Main Results:

• Six priority areas for documentation improvement were identified, including a summary note feature.
• Post-update, consult documentation increased, and time to closure reduced by 4.5 days.
• Documentation quality improved, with "above-bar" scores rising from 78% to 89% (n=140).

Conclusions:

• Simplification of IEWeb decreased documentation burden and improved consultant satisfaction.
• Enhanced IEWeb led to increased documentation frequency and clinically meaningful quality improvements.
• The updated system allows ethics consultants to refocus efforts on core documentation tasks.