Evaluation of Embedded Ethicist Model in Critical Care
CCCF ePoster library. Connolly E. Oct 2, 2017; 198176; 22
Eoin Connolly
Eoin Connolly
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Abstract
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Evaluation of Embedded Ethicist Model in Critical Care

Connolly, Eoin1, Godkin, Dianne2, Mansfield, Elizabeth3, Jayawardena, Sinasi4

1 Regional Ethics Program, Trillium Health Partners, Mississauga, Canada

2 Regional Ethics Program, Trillium Health Partners, Mississauga, Canada

3 Institute for Better Health, Trillium Health Partners, Mississauga, Canada 

4 Mississauga Academy of Medicine, University of Toronto, Mississauga, Canada


Introduction
Critical care units are complex, fast-paced environments where many types of ethical issues can arise.  There is evidence that patients in critical care environments do not always receive treatment that is consistent with their wishes and values. For example, Heyland and colleagues (2015) compared expressed preferences and documented orders for use of CPR in 16 hospitals and found discordance in 37% of patients. Such communication shortfalls most often result in patients being over-treated.  The presence of a clinical ethicist as part of the healthcare team during meetings with patients and family members can support treatment decision-making and the resolution of ethical uncertainties (Bruce et al., 2014).  It has also been demonstrated that ethics consultations in the critical care environment can reduce the number of days on mechanical ventilation as well as reduce the length of stay for critical care patients who do not survive to discharge (Schneiderman et al., 2000).
Objectives & Methods
The purpose of this evaluation is to determine the impact and effectiveness of the Embedded Ethicist Model and to identify areas where further improvements can be made. A mixed qualitative/quantitative methodology is being used.  Findings of the quantitative component of the evaluation are presented. Outcome measures were compared during the three six month time periods.  Patient data was collected for all patients who spent some or all of their hospitalization in critical care and did not survive to discharge.  Quantitative outcomes measures include:
•number of ethics consultations/hours of education;
•patient average length of stay in critical care (ICU ALOS);
•total patient length of stay (Total ALOS); and
•number of days on a ventilator (Vent Days).
The qualitative component of the evaluation includes focus groups and interviews of key stakeholders to explore their experiences of the Embedded Ethicist Model. 
Results/Conclusion
Since the initiation of the Embedded Ethicist Model, the number of ethics consultations in the ICU have increased more than five fold and this increase was sustained across time. It is most likely that this can be attributed to more frequent, consistent, and direct access to the embedded ethicist. The number of hours of ethics education directly tailored to critical care healthcare providers also increased.  Patient demographics remained similar across time periods, although there was an increase in the number of patients who did not survive to discharge in the 6 and 12 month post-implementation time periods.  A significant reduction in average length of stay in critical care from 11 to 8.6 days (p<.05) was noted. It is hypothesized that the ethicist’s role in supporting conversations about goals of care between the ICU team and the patient or patient’s substitute decision maker(s) was a contributing factor to this decrease. There were no significant changes in total length of stay in hospital or number of days on a ventilator.  Completion of the qualitative component of the evaluation will provides a better understanding the impact and effectiveness of the Embedded Ethicist Model from the perspective of stakeholders including front-line staff and leaders. Findings from the evaluation will be used to inform further development of the Embedded Ethicist Model.

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