Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Pediatrics, University of Nebraska, Omaha, Nebraska.
Hosp Pediatr. 2022 Sep 1;12(9):e291-e294. doi: 10.1542/hpeds.2022-006662.
Ethics consultation services (ECS) support clinical decision-making when there are values conflicts. Accessibility to ECS by patients and families is required to benefit from the service. Multiple national guidelines encourage ready availability of ECS to all stakeholders including patients and families.
All facilities registered with the Children's Hospital Association (n = 190) were contacted using a protocol modeled after an adult ethics consultation practice study. After an online search to identify an ethics contact, calls were made to hospital operators, and each transfer was documented as well as time to ECS contact. If no contact was identified on progression through the call protocol or on completion of the call pathway on 3 occasions each spaced by 1 week, the ECS was labeled "unreached."
Only 36 (19%) ECS contacts were identified via online search with the remainder 154 (81%) requiring phone calls. Fewer than one-quarter of operators (n = 34/154, 22%) could identify a contact name or number for ECS. Thirty ECS (16%) remained unreachable after completion of the call pathway or 3 separate attempts. Successful ECS contact required an average of 2.9 attempts. Maximum call hold duration was 25 minutes. Callback times averaged 5.8 business days after voicemail.
This study revealed limited reachability of ECS. ECS should make their contact information available online and improve information available to operators.
当存在价值观冲突时，伦理咨询服务（ECS）可支持临床决策。患者和家属需要能够获得 ECS，才能从中受益。多项国家指南鼓励向包括患者和家属在内的所有利益相关者提供随时可用的 ECS。
使用模仿成人伦理咨询实践研究的方案，联系了与儿童医院协会（n=190）注册的所有机构。在线搜索以确定伦理联系人后，拨打了医院运营商的电话，并记录了每次转接以及与 ECS 联系的时间。如果在电话协议的推进过程中或在 3 次每次间隔 1 周的电话途径完成后没有找到联系人，则将 ECS 标记为“无法联系”。
仅通过在线搜索识别了 36 个（19%）ECS 联系人，其余 154 个（81%）需要电话联系。不到四分之一的运营商（n=154，22%）能够识别 ECS 的联系人姓名或号码。在完成电话途径或 3 次单独尝试后，仍有 30 个 ECS（16%）无法联系。成功联系 ECS 需要平均 2.9 次尝试。最长的电话等待时间为 25 分钟。语音邮件后的回调时间平均为 5.8 个工作日。
本研究表明 ECS 的可及性有限。ECS 应在线提供其联系信息，并改善运营商可获得的信息。
