High Clinical Ethics Consultation Volume: A Blessing or a Bane?

Abstract: A clinical ethics program ought to provide justified, rigorous, and practical guidance about normative aspects of clinical medicine. A program that fulfills this imperative to their own satisfaction, and satisfaction of the institution, is likely a successful program. Consult volume is often taken as the cardinal metric for success. With this panel, four clinical ethics directors discuss how their services meet this aim by appealing to factors other than case volume.

Panelist 1 directs a recently created program at a large community health system in the Midwest. Leading a new program with a rapidly growing consultation service, this panelist will highlight select drawbacks of focusing on maximizing consult volume, particularly for new programs with limited resources.

Panelist 2 leads a large ethics consultation service for a not-for-profit, Protestant hospital in the South. He will discuss the programmatic changes that lead the service to intentionally decrease the service’s consult volume, while aiming to increase the complexity of the consults.

Panelist 3 directs an established ethics center at a faith-based, community healthcare system in the Pacific Northwest. He will highlight efforts to promote professionalism within an organization with multiple facilities, across the healthcare continuum. This will include a discussion of establishing value while coexisting alongside volunteer-based models.

Panelist 4 leads a well-established ethics consult service at an academic, government-sponsored hospital on the East coast. She will highlight ways of assessing the added value of an ethics consult service that includes metrics such as “impact stories,” consult evaluation scores, and evaluated educational activities.