Pediatric Clinical Ethics Consultation: Organizational Issues

Abstract

Research Article| January 01 2010 Pediatric Clinical Ethics Consultation: Organizational Issues AAP Grand Rounds (2010) 23 (1): 9. https://doi.org/10.1542/gr.23-1-9 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Pediatric Clinical Ethics Consultation: Organizational Issues. AAP Grand Rounds January 2010; 23 (1): 9. https://doi.org/10.1542/gr.23-1-9 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: ethics, clinical, ethics Source: Opel DJ, Wilfond BS, Brownstein D, et al. Characterisation of organizational issues in paediatric clinical ethics consultation: a qualitative study. J Med Ethics. 2009; 35(8): 477– 482; doi: https://doi.org/10.1136/jme.2008.027896Google Scholar Investigators from the University of Washington School of Medicine sought to identify and characterize organizational issues related to the ethical concerns that prompted patient-based pediatric ethics consultations at Seattle Children’s Hospital between 1996 and 2006. The medical records of study patients were reviewed looking for organizational issues germane to the ethics consultation. Prior to reviewing the data, four categories of organizational issues were defined: management, organizational culture, transfer of knowledge, and protocols and processes. Within these broad groups a total of 18 sub-categories were defined. Consultation notes were coded by independent observers for the presence of one or more types of organizational issues, and agreement between reviewers was assessed. Directed content analysis was used to identify whether an organizational issue related to the development of adverse clinical events and extended to ethics concerns. Among 71 consultations on patients aged 7 days to 21 years, most originated from the neonatal or pediatric intensive care units. One or more organizational issues were identified as contributing to the ethics issues in 96% of the consultations. The kappa statistic for agreement between reviewers regarding the presence of an organizational issue was >0.6, indicating greater than moderate agreement. The most frequent issues impacting the consultative process were: 1) organizational culture, where medical-ethical practices were guided by informal standards rather than defined policy – ie, an absence of a policy; 2) policy and procedure problems, where a particular organizational policy was available but not followed; and 3) poor communication between staff. Understanding these issues may suggest ways to prevent recurrence of similar ethical concerns and improve patient-doctor satisfaction. The authors of the current study identify three major systemic issues that can lead to stress for the patient, family, and medical staff, moral distress of the staff, and poor utilization of resources. By establishing administrative accountability coupled with evaluation and reporting processes, these problems can be lessened. For the ethics consultative process to work most effectively within a health care facility, the administration must be supportive, approachable, and willing to engage in discussions regarding clinical bedside care. Whereas both organizational ethics and directed bedside ethics (clinical consultative process) are concerned with patient care and well-being, the organizational aspect views ethical issues from a different, distinctly broader perspective.1 Organizational ethics has to do with the values of the organization. Elements that are conducive to ethical behavior within the organization include: 1) a written code of ethics and standards; 2) ethics training for all members of the organization; 3) availability for advice on ethical situations; and 4) systems for confidential reporting. The values of an organization are in part manifest by its maintenance and use of resources, budgets, accountability, administration, and its approach to evaluation, training, and education. A good example is the gathering... You do not currently have access to this content.