Ethics Consultation Quality Assessment Tool: A Novel Method for Assessing the Quality of Ethics Case Consultations Based on Written Records

Abstract

Although ethics consultation is offered as a clinical service in most hospitals in the United States, few valid and practical tools are available to evaluate, ensure, and improve ethics consultation quality. The quality of ethics consultation is important because poor quality ethics consultation can result in ethically inappropriate outcomes for patients, other stakeholders, or the health care system. To promote accountability for the quality of ethics consultation, we developed the Ethics Consultation Quality Assessment Tool (ECQAT). ECQAT enables raters to assess the quality of ethics consultations based on the written record. Through rigorous development and preliminary testing, we identified key elements of a quality ethics consultation (ethics question, consultation-specific information, ethical analysis, and conclusions and/or recommendations), established scoring criteria, developed training guidelines, and designed a holistic assessment process. This article describes the development of the ECQAT, the resulting product, and recommended future testing and potential uses for the tool.

The use of an online comment system in clinical ethics consultation

“…Further, comments about the contextual features or issues present in a case demonstrate reflection about all elements of proper ethics consultation: the identification of the ethical question, the consideration of relevant consultation specific information, an appropriate ethical analysis, conclusion, and recommendations (Pearlman et al 2016). For example, clarification comments or recommendations for additional services provide clear evidence of how the comment system can improve the performance of ethics consultation.…”

“…For example, clarification comments or recommendations for additional services provide clear evidence of how the comment system can improve the performance of ethics consultation. Pearlman and colleagues (2016) suggest that quality ethics consultation is informed by relevant consultation-specific information, such as patient preferences and medical and social facts, and that the appropriate sources and processes have been used to obtain these facts. Requests for additional information or details ensure that consultants have not overlooked potentially important elements, and suggestions for additional services enable the ethical analysis and recommendations to reflect the best possible range of available and appropriate options.…”

“…This process is very useful in establishing whether individuals can reliably perform quality ethics consultation, but is distinct from establishing whether a particular consultation is of high quality. The Ethics Consultation Quality Assessment Tool (ECQAT) also strives to assess these key ethics consultation skills, evaluating whether a particular consultation meets quality standards (Pearlman et al 2016). However, both these metrics of quality assurance are retrospective in nature; the unique value of an online comment system is that it allows for the assessment of ethics consultation in real time, improving and assuring quality in the index case.…”

What Quality Is Actually Assessed Within Written Records?

“…More specifically, the tool states that an adequate consultation response contains "relevant information necessary to answer the question," including the "preferences, values, and interests" of relevant stakeholders (Pearlman et al 2016, Table 1). To answer the question of how we should assess written consultation records, we need to know the preferences of those who…”

Strategies to Improve Health Care Ethics Consultation: Bridging the Knowledge Gap

“…We will ask HCEC practitioners and administrators in a random sample of 600 US hospitals about their HCEC practices and their views on potential improvement strategies. We also plan to assess HCEC quality through a review of 300 written consultation records using a rigorous scoring method I developed with my former colleagues at the National Center for Ethics in Health Care [30].…”