Was the Consult Effective? Ethicists Survey Requestors

By Stacey Kusterbeck

If ethics programs really want to know how well they are doing, individuals who participated in consults are ideal sources of information. To obtain this valuable feedback, some ethics programs are using surveys.

At New Hyde, NY-based Northwell Health, the quality of individual ethics consultants, and the ethics consultation service in general, are measured by surveys. Anyone who requests a consult receives an email survey after the consult is completed.

“Performance measures include timeliness of the consult; the likelihood of utilizing the ethics service again; the helpfulness of the consultation in resolving the ethical issue; satisfaction with the consultation; and the ability of the consultant to communicate effectively with the team, patient and surrogates,” reports Renee McLeod-Sordjan, DNP, PhD, FNAP, FNYAM, FAME, FAAN, director of the Division of Medical Ethics.

People can add additional comments if they wish. “We learned a lot about perceptions of what ethics does,” reports McLeod-Sordjan.

Some clinicians assumed that ethics only helped with end-of-life cases and were surprised that ethicists assisted with many other issues, such as ensuring patients received care concordant with their values and goals.

At SSM Health St. Anthony Hospital in Oklahoma City, ethicists email a survey to participants in ethics consults. The survey asks these questions:

• Was the response timely?

• Was the investigation thorough?

• Were you satisfied with the process?

• Were you satisfied with the ethicist’s recommendation?

Ethics consults, by their very nature, involve a conflict of some sort. Thus, unhappiness with the recommendation can happen even if the ethicist provided a high-quality consultation. “Some of the issues we address are not easily resolved,” observes Cheyn Onarecker, MD, MA, director of St. Anthony Family Medicine Residency. Onarecker also is chair of the Healthcare Ethics Council at Trinity International University’s The Center for Bioethics & Human Dignity.

Ethicists are careful to consider multiple members’ viewpoints before issuing reports.

“Our primary goal, of course, is not to make the requestor happy. But we certainly want that person to feel that they have been heard, that their request has been taken seriously, and that we have expended the appropriate amount of time and effort to provide helpful recommendations,” says Onarecker.

Ethicists receive the survey feedback as a compilation of the responses from multiple individuals. Sometimes respondents offer specific comments or concerns. Ethicists can respond to those comments, which the respondent can view while remaining anonymous. “This gives us a chance to explain our actions,” says Onarecker.

Ethicists rarely receive complaints about consults, even in cases where the respondent disagreed with their recommendations. “Although our committee operates in an advisory capacity only, we have a solid reputation, and our recommendations have real influence,” notes Onarecker. Onarecker reports that survey respondents voiced these issues regarding the ethics committee:

• Clinicians want a quicker response when they reach out to ethics.

“Occasionally, cases require an almost immediate response. That can be difficult, especially on weekends or holidays,” says Onarecker.

• Clinicians want ongoing follow-up from the ethics committee.

“One of the keys to a successful ethics committee consultation is maintaining excellent communication with all parties involved. That is a huge challenge when our staff is so small and made up of professionals with major responsibilities,” says Onarecker. For example, Onarecker is a clinical ethicist, but his primary role is a residency program director.

Ethicists typically hold a family meeting and document their recommendations. However, ethicists have to keep everyone apprised of new developments. For example, if the patient’s clinical condition changes, family members who objected to withdrawing life-sustaining interventions may change their minds. The clinical team members also change. Hospitalists and specialists switch from one week to the next, for instance. Ethicists can use good documentation to keep the new team apprised of the ethicist’s recommendations, says Onarecker.

• Clinicians expect ethicists to enter a report in the electronic medical record within 24 hours after the consult.

“Given the fact that we have a small staff who volunteer their time to the committee, we can’t always respond that quickly,” acknowledges Onarecker. To meet the 24-hour deadline, ethicists sometimes submit a brief summary of the ethics question, along with a note stating that a more detailed note will be submitted shortly.

• Clinicians want more transparency on ethicists’ decision-making.

Ethicists encourage requestors to discuss the recommendations if they want to know more than what is included in the report. “We include as much of the decision-making process as we can in our reports, without making them so long that no one would ever read them,” says Onarecker.