Nurse Ethicist Children's Healthcare of Atlanta Lilburn, Georgia
Abstract: The bioethics committee at a pediatric institution noted an increasing number of ethics consults regarding the appropriateness of tracheostomy placement. To explore this trend, the committee reviewed ethics consults from the past seven years, identifying 25 cases. Half were due to healthcare provider concerns about goals of care or patient quality of life, while nearly one-fourth stemmed from patient or parent refusal. Consults occurred in intensive care units, primarily the Pediatric Intensive Care Unit (PICU), and most patients had an underlying neurological condition requiring a tracheostomy. The majority were under age five, with 36% having Department of Family and Child Services involvement. Almost half also had palliative care involvement. Most consults were initiated by physicians, while only 28% came from nurses—lower than the institutional nurse-placed consult average (42.9%). Ultimately, 64% of these patients received a tracheostomy. The prevalence of provider-driven concerns about quality of life suggests a need for earlier discussions to address these issues proactively. The bioethics committee is currently implementing a tracheostomy workgroup to disseminate this data and initiate conversations among appropriate stakeholders.
After participating in this conference, attendees should be able to:
Evaluate the ethical dilemmas surrounding tracheostomy placement in pediatric patients, including patient quality of life, provider concerns, and family-decision making.
Identify approaches to integrate ethics support earlier in the decision process to minimize reactive ethics consults.
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