Preventative Ethics in the Pediatric Intensive Care Unit: Use of an Automated Time-Based Consult Order

Suzie Ciruzzi – St. Jude Children's Research Hospital; Deena Levine – St. Jude Children's Research Hospital; Ray Morrison – St. Jude Children's Research Hospital

Abstract: Empirical literature shows perceptions of non-beneficial treatment and questions about goals of care as common reasons for ethics consultations and commons sources of moral distress. Such situations commonly arise in the intensive care unit (ICU) and strategies for early intervention are needed. We sought to assess the feasibility of using a time-based automatic consult to facilitate involvement of ethics into interdisciplinary rounds as a form of preventative ethics in a subspecialty pediatric ICU.

Through use of the electronic medical record (EMR), an ethics consultation order occurs on ICU Day 5. Ethics reviews the case and assigns a rounding priority (urgent – round within 48 hours, standard – round within 72 hours, or low – patient expected to leave ICU, follow remotely until ICU discharge). Ethics is treated as a "system” on rounds with a rounding note is placed in the EMR unless the consultant identifies the need for a full consultation. After the initial encounter, ethics follows the patient through ICU discharge. The Armstrong Clinical Ethics Coding System is used to track potential ethics concerns.

We will present 9 months of preliminary data and discuss the feasibility of implementing a time-based system for early involvement of ethics in the ICU as the form of preventative ethics. Anecdotally, this process is normalizing the role of clinical ethics in the ICU setting and allowing earlier involvement of ethics in the care of complex, critically ill children. It is acceptable to patients and medical staff, without being overly burdensome to the ethics service.

Keywords: Preventative Ethics, Pediatric ethics, Clinical Ethics