Priya H Marathe1, Hao Zhang2, Liz Blackler3,4, Peter D Stetson3,5, Louis P Voigt2,4,5,6,7, Danielle Novetsky Friedman1,4,8. 1. Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY. 2. Department of Anesthesiology, Pain, and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY. 3. Office of the Physician-In-Chief, Memorial Sloan Kettering Cancer Center, New York, NY. 4. Ethics Committee, Memorial Sloan Kettering Cancer Center, New York, NY. 5. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY. 6. Department of Anesthesiology, Weill Cornell Medical College,New York, NY. 7. Department of Medicine, Weill Cornell Medical College, New York, NY. 8. Department of Pediatrics, Weill Cornell Medical College, New York, NY.
Abstract
PURPOSE: As the role of clinical ethics consultation in health care advances, there are calls to standardize the process of consultation. The Ethics Committee at Memorial Sloan Kettering Cancer Center (MSK) hypothesized that the process of requesting an ethics consultation could be improved by instituting an electronic health record (EHR) order for consultation requests. This report summarizes the impact of adopting an EHR order for ethics consultation requests at MSK. METHODS: This retrospective review of all clinical ethics consultations requested at a tertiary cancer center from May 2017 to February 2020 spans 17 months before and after implementation of an electronic order for consultation requests. Summary statistics are presented using Pearson chi-square analyses with a significance level of 0.05. RESULTS: There was a significant increase in the total number of consultation requests placed after implementation of the EHR order (n = 165, 0.08% of total patients) compared with before (n = 108, 0.05% of total patients; P = .007). The number of consults requested by providers from inpatient (P = .02) and outpatient (P = .04) settings significantly increased. The proportion of consults placed by medical versus nonmedical providers remained unchanged (P = .32). CONCLUSION: In this large single-institution retrospective study, implementation of an EHR order for ethics consultation requests was associated with a significant increase in the number of consultation requests. Implementation of an electronic order may decrease barriers to ethics consultation in diverse practice settings. Further longitudinal, multicenter studies are needed to assess strategies to improve access to clinical ethics consultation for oncology patients.
PURPOSE: As the role of clinical ethics consultation in health care advances, there are calls to standardize the process of consultation. The Ethics Committee at Memorial Sloan Kettering Cancer Center (MSK) hypothesized that the process of requesting an ethics consultation could be improved by instituting an electronic health record (EHR) order for consultation requests. This report summarizes the impact of adopting an EHR order for ethics consultation requests at MSK. METHODS: This retrospective review of all clinical ethics consultations requested at a tertiary cancer center from May 2017 to February 2020 spans 17 months before and after implementation of an electronic order for consultation requests. Summary statistics are presented using Pearson chi-square analyses with a significance level of 0.05. RESULTS: There was a significant increase in the total number of consultation requests placed after implementation of the EHR order (n = 165, 0.08% of total patients) compared with before (n = 108, 0.05% of total patients; P = .007). The number of consults requested by providers from inpatient (P = .02) and outpatient (P = .04) settings significantly increased. The proportion of consults placed by medical versus nonmedical providers remained unchanged (P = .32). CONCLUSION: In this large single-institution retrospective study, implementation of an EHR order for ethics consultation requests was associated with a significant increase in the number of consultation requests. Implementation of an electronic order may decrease barriers to ethics consultation in diverse practice settings. Further longitudinal, multicenter studies are needed to assess strategies to improve access to clinical ethics consultation for oncology patients.
Authors: April Savoy; Laura G Militello; Himalaya Patel; Mindy E Flanagan; Alissa L Russ; Joanne K Daggy; Michael Weiner; Jason J Saleem Journal: J Biomed Inform Date: 2018-07-30 Impact factor: 6.317
Authors: Andrew G Shuman; Sacha M Montas; Andrew R Barnosky; Lauren B Smith; Joseph J Fins; Mary S McCabe Journal: J Oncol Pract Date: 2013-06-18 Impact factor: 3.840