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 7Â days less than patients who survived; members in ethics proactive group had predicted ICU stays 6Â 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] |