Ethics Consultation in U.S. Hospitals: New Findings about Consultation Practices.

BACKGROUND While previous research has examined various aspects of ethics consultation (EC) in U.S. hospitals, certain EC practices have never been systematically studied. METHODS To address this gap, we surveyed a random stratified sample of 600 hospitals about aspects of EC that had not been previously explored. RESULTS New findings include: in 26.0% of hospitals, the EC service performs EC for more than one hospital; 72.4% of hospitals performed at least one non-case consultation; in 56% of hospitals, ECs are never requested by patients or families; 59.0% of case consultations involve conflict; the usual practice is to visit the patient in all formal EC cases in 32.5% of hospitals; 56.6% of hospitals do not include a formal meeting in most EC cases; 61.1% of hospitals do not routinely assess ethics consultants' competencies; and 31.6% of hospitals belong to a bioethics network. We estimate the total number of non-case consultations performed in U.S. hospitals to be approximately one half the number of case consultations; we estimate the total number of ECs performed in U.S. hospitals, including both case and non-case consultations, to be just over 100,000 per year. CONCLUSIONS These findings expand our current understanding of EC in U.S. hospitals, and raise several concerns that suggest a need for further research.