Implementation and Impact of Proactive Ethics Rounds in an Emergency Department-Based ICU environment

Timothy Gilbert, MD, MPH – Wayne State University; Janice Firn, PhD, LMSW, HEC-C – University of Michigan

Abstract: Proactive ethics rounds – interprofessional rounding to identify ethical conflict, encourage moral reflection on the delivery of care, and provide just-in-time ethics education – have been shown to relieve moral distress and foster moral resilience. Proactive rounds are often implemented in the intensive care unit (ICU) setting. There is no prior literature describing implementation of proactive ethics rounds in the emergency department (ED) where moral distress and burnout are at an all time high. The ED at our institution has also historically been a low utilizer of ethics consultation services. In this presentation, we describe the implementation of a 3-month-long pilot of proactive ethics rounds in an unique ED-based intensive care environment known as the Emergency Critical Care unit (EC3). Multiple job families were invited to participate in rounds, including nurses, respiratory therapists, pharmacists, social workers, physician assistants, medical trainees, and attending physicians. We discuss the key stakeholders involved in coordinating rounds and major barriers to implementation. We further describe results of pre- and post-intervention surveys that assessed levels of moral distress, ethics systems knowledge, and perceptions of the intervention in the various job families that provide care in EC3. Finally, we reflect on lessons learned and transferability of the proactive rounding model to other settings.

Keywords: Proactive ethics rounds, Emergency department, Moral distress