Nilson Elizabeth G, Acres Cathleen A, Tamerin Naomi G, Fins Joseph J
Division of Medical Ethics, Weill Medical College of Cornell University, New York, New York, USA.
Am J Med Qual. 2008 Sep-Oct;23(5):356-64. doi: 10.1177/1062860608316729.
The Institute of Medicine's quality imperatives include the need to provide safe, effective, patient-centered, timely, efficient, and equitable care. Less attention has been paid to quality metrics as they relate to the assessment of clinical ethics consultation and its impact on care. A better understanding of how ethics consultation influences the quality of care might identify opportunities for improvement. A descriptive pilot study, involving 7 hospitals in the New York-Presbyterian Healthcare System, was conducted to identify key elements of the ethics consultative process that might impact clinical and psychosocial outcomes. A majority of consults involved medical or intensive care unit patients and end-of-life decision making; 75.5% had or received a do-not-resuscitate order, 90.6% lacked decision-making capacity, 43.4% had an advance directive. Conflict existed in a majority. Future research should include surrogate decision making, patients on nonmedical services who may have unrecognized ethical dilemmas, and the role of conflict in clinical care.
美国医学研究所的质量要求包括提供安全、有效、以患者为中心、及时、高效和公平的医疗服务。与临床伦理咨询评估及其对医疗服务的影响相关的质量指标较少受到关注。更好地理解伦理咨询如何影响医疗服务质量可能会发现改进的机会。一项描述性试点研究在纽约长老会医疗系统的7家医院开展，旨在确定伦理咨询过程中可能影响临床和心理社会结果的关键因素。大多数咨询涉及内科或重症监护病房患者以及临终决策；75.5%的患者有或接受了“不要复苏”医嘱，90.6%的患者缺乏决策能力，43.4%的患者有生前预嘱。大多数存在冲突。未来的研究应包括替代决策、可能存在未被认识到的伦理困境的非医疗服务患者以及冲突在临床护理中的作用。
