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Table 9 Resource factors reporting

From: Clinical ethics consultations: a scoping review of reported outcomes

Resource factors assessed (name construct)

Outcome description

Outcome measure

Results

Reference #

Length of Stay

Length of stay in hospital and length of stay in ICU

Record review (Chart review)

Membership in ethics proactive group and discharge status were significantly related to length of ICU stay** Those who died had predicted ICU stays of 7 days less than patients who survived; members in ethics proactive group had predicted ICU stays 6 days less than other 2 groups

[60]

Length of Stay

Number of inpatient hospital days

Record review (Medical record)

In patients who failed to survive to hospital discharge, intervention group had fewer days in hospital than control (split evenly between ICU/non-ICU hospital days**

Intervention group had greater % of pts with 4–9 days and fewer pts with > 10 days, compared to control group (therefore ethics consultation more effective in reducing lengths of stay among those who would otherwise remain in hospital for 10 days or more)

[64]

Consumption of medical resources

Length of ICU stay, length of hospital stay, post-conflict length of ICU stay, post-conflict length of hospital stay (post-conflict = after occurrence of medical uncertainty or conflict regarding value-laden issues)

Record review (Medical record)

Participants in HCEC group showed significant reductions in entire ICU stay** and entire hospital stay*

Participants in HCEC group had shorter ICU stay** and shorter hospital stay** after medical uncertainty/conflict than participants in UC group

[65]

Days in Hospital

Hospital length of stay and ICU length of stay

Record review (Medical record)

Hospital LOS (median days):

Intervention (N = 56): N = 23

Control (N = 52): N = 21

ICU LOS (median days):

Intervention (N = 56): N = 11

Control (N = 52) l: N = 11

[48]

Total cost of stay

Total cost of hospital stay

Record review (Medical record review subjected to cost assessment)

Intervention (N = 52): $167,350.00

Control (N = 56): $164, 670.00

[48]

Cost avoidance

Costs for patient's tx and expenses that were avoided or added for each patient who received a consultation

Total Cost avoidance = hospitals' variable costs (direct patient care like supplies, nurses, technicians, etc.) + fixed costs (hospital overhead e.g., managers, administrators, equipment depreciation, etc.)

Cost-Avoidance Factors: days in hospital, cost of resuscitation, surgical/diagnostic procedures, other, hospital expense for consultation service

Mixed methods (Medical records for actual financial hospital costs; interview with primary physician who indicated whether ethics consultation helped patient avoid medically inappropriate/undesired tx, whether consultation supported continuing tx/adding new tx, or no effect on patient's tx—this information was provided to the hospital comptroller who determined the costs for the patient’s treatment and expenses avoided)

Ethics consultation resulted in substantial cost avoidance: 20/29 consultations resulted in cost avoidance; 3/29 resulted in "potential cost savings," would've resulted in savings if primary physician accepted consultant's recommendation

Hospital avoided $143,683 in variable costs and $288,827 in total costs; savings obtained by decreasing length of hospital stays, costs associated with resuscitation, # surgical/diagnostic procedures, other factors

Hospital expenses for ethicist/supporting resources = $12,000

[75]

Hospital costs

Total inpatient stay costs were calculated as total service costs plus daily acute inpatient and ICU room-and-board costs; costs then aggregated to level of person for the hospital stay

Estimated net cost of an ethics consultation practice from diff sources: annual cost of practice itself at ~ $150,000, estimated to be approx 1/2 FTE physician and full-time admin assistant plus office space in hospital including overhead; cost calculated as estimated incremental per person cost savings of intervention x # consultations expected in a year

Record review (Medicare cost reports obtained from finance departments of study hospitals)

6 hospitals averaged 40 ICU beds with ~ 50pts per year = savings of $5246 for reductions in nonbeneficial treatment among those who died in hospital = estimated savings of hospital tx costs $157,380 with an ethics consultation practice

[64]

Hospital charges

Charges for patients

Record review (Records obtained through fiscal services)

Proactive group patients who died had 16% reduction in average charges compared to baseline and 33% reduction compared with control patients; but was NOT statistically significant

[60]