By Stacey Kusterbeck
As hospitals continue to merge and expand their geographic footprint, ethicists must meet the needs of clinicians at all those care settings. “Ethicists are primarily involved in dilemmas on the inpatient side, even though ethical dilemmas absolutely exist in outpatient settings,” says Andria Bianchi, PhD, a clinical ethicist at the Centre for Clinical Ethics at Unity Health Toronto.
Bianchi practices in post-acute care settings, each of which has outpatient settings available. Many outpatient clinicians do not realize they can consult with an ethicist when dilemmas arise. “In order to overcome this obstacle, I’ve offered education and worked to develop relationships with those working in outpatient clinics,” says Bianchi.
Outpatient providers are accustomed to operating without the support of ancillary services that inpatient settings may take for granted. That includes ethics consultation, says Caroline Buchanan, PhD, MA, HEC-C, an assistant professor in the Program for Bioethics at UK College of Medicine.
Sometimes, a seemingly small issue gets in the way of a successful outpatient ethics consultation. Some electronic medical records will not allow ethics consultants to document correctly in an outpatient chart. Some ethics services are not set up to respond to an outpatient provider needing an urgent consult while a patient is in their clinic.
On the provider side, outpatient clinics are busy and fast-paced, leaving little time in the day to speak with an ethicist. Outpatient providers lack the flexibility to accommodate an ethicist’s on-the-spot visit to discuss a case. “These barriers are certainly not insurmountable. Often, they simply represent a disruption in workflow for both the outpatient provider and the ethics service — one that is important to address,” says Buchanan.
Ethics consultants can facilitate outpatient consults with these approaches, offers Buchanan:
- arranging to accompany the provider at a patient’s clinic visit;
- conducting a remote consult;
- attending morning meetings or table rounds for clinics that run through their patients as a group.
“Other times, retrospective case review via an ethics committee can support outpatient providers facing a persistent ethical question who need support, by establishing best practices for their clinic,” says Buchanan.
As hospitals continue to merge and expand their geographic footprint, ethicists must meet the needs of clinicians at all those care settings.
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