The Presence of Ethics Programs in Critical Access Hospitals

Abstract

The purpose of this study was to assess the presence of ethics committees in rural critical access hospitals across the United States. Several studies have investigated the presence of ethics committees in rural health care facilities. The limitation of these studies is in the definition of 'rural hospital' and a regional or state focus. These limitations have created large variations in the study findings. In this nation-wide study we used the criteria of a critical access hospital (CAH), as defined by the Medicare Rural Hospital Flexibility Program (Flex Program, 2007), to bring consistency and clarity to the assessment of the presence of ethics committees in rural hospitals. The Flex Monitoring Team conducted a national telephone survey of 381 CAH administrators throughout the United States. The survey covered a wide variety of questions concerning hospitals' community benefit, impact activities, and whether the hospital had a formally established an ethics committee. About 230 (60%) of the respondents indicated they had a formally established ethics committee or ethics consultation program at their CAH. The prevalence of ethics committees declined as the CAH location became increasingly rural along a rural-urban continuum. Unlike CAHs, all rural Department of Veterans Affairs Medical Centers have ethics committees. The results of this study provide an understanding of the limited presence of ethics committee in rural America and the need to consider new approaches for providing ethics assistance. A virtual ethics committee network may be the most efficient and effective way of providing rural hospitals access to a knowledgeable ethics committee or consultant.

Clinical Ethics Support in Contemporary Health Care

“…Most studies of ethics support services have sought to establish aspects such as: the prevalence of support services, their type, structure, composition, main functions, activities and processes (see for example McGee et al, 2001;Slowther et al, , 2004Slowther, McClimans, and Price, 2012;Godkin et al, 2005;Milmore, 2006;Fox, Myers, and Pearlman, 2007;Frewer and Fahr, 2007;Swetz et al, 2007;Pedersen, Akre, and Førde, 2009;Romano et al, 2009;Whitehead et al, 2009;Kesselheim, Johnson, and Joffe, 2010;Gaudine et al, 2010;Nelson et al, 2010b;Tapper et al, 2010;Moeller et al, 2012). What these studies mostly show is the diversity of CES services.…”

Ethical and Legal Challenges During the COVID‐19 Pandemic: Are We Thinking About Rural Hospitals?

“…20 Smaller hospitals, including community hospitals and rural institutions, frequently have less organized or nonexistent ethics teams. 21 When ethics teams do exist in these facilities they may meet infrequently, be consulted infrequently, and lack robust support from the health care and lay communities. Further, local relationships in rural areas are often overlapping, which further complicates ethical decision-making as objective parties with appropriate knowledge and perspective are sometimes not available.…”

“…Smaller hospitals, including community hospitals and rural institutions, frequently have less organized or non‐existent ethics teams 21 . When ethics teams do exist in these facilities they may meet infrequently, be consulted infrequently, and lack robust support from the health care and lay communities.…”

The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis

“…Hospital characteristics also were obtained from the NYS DOH ICRs in addition to the NYS DOH Cardiac Surgery Reporting System, 17,18 the NYS Trauma Registry, 19,20 and the Flex Monitoring Team for critical access hospitals. 21,22 Additionally, population characteristics were obtained at the county level from the Area Health Resource File (AHRF). 23 This study was considered exempt from institutional review board review by the University of Pennsylvania.…”