NICU Ethics Rounds: A 48-Month Pre-Post Intervention Study

Abstract: Ethics rounds are purported to improve a frontline team’s ability to manage ethics issues. However, evidence of quantified outcomes is sparse. This project began with the premise that if ethics rounds improve a team’s ability to manage ethical issues, evidence of such should be identifiable by analyzing the ethics consult requests before and after the initiation of rounds. We sought to measure the effects of supplementing existing clinical ethics consultation services with weekly ethics rounds in our 106-bed NICU. Any team member could nominate a case, and once weekly a multidisciplinary team would meet to discuss the case. A pre/post time series study design was used to investigate impact. In the post period, the day of the patient’s hospitalization on which ethics was consulted decreased from a mean of 32.3 days to 24.5 days. Average case complexity decreased from 2.4 to 2.1 on a 4-point scale. Average length of stay decreased from 73.5 days to 59.2 days (n=125). Qualitatively, we found consults involving moral distress decreased (59%) while the team’s willingness to question some parental choices increased (45%). As ‘basic’ consults decreased a broader variety of ethical questions emerged, suggesting consult volumes change, but not necessarily diminish, with increased ethics support.

Keywords: Ethics Rounds, NICU, Pre-Post Intervention Study