Pediatric Ethics Consultation Services

doi:10.1542/peds.2022-058947

2023-02-01

DOI：10.1542/peds.2022-058947

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摘要

En 中文

This national registry quantifies the presence of pediatric ethics consultation services (PECS) in children's hospitals in the United States and compares the structural environment of settings with and without PECS. BACKGROUND AND OBJECTIVEAlthough guidelines call for the presence of pediatric ethics consultation services (PECS), their existence in children's hospitals remains unquantified. This study determined the prevalence of PECS in children's hospitals and compared the practice environments of those with versus without PECS. METHODThe Children's Hospital Association Annual Benchmark Report survey from 2020 and PECS data were analyzed for the association of PECS with domains of care. RESULTSTwo hundred thirty-one hospitals received survey requests, with 148 submitted and 144 reachable to determine PECS (62% response rate), inclusive of 50 states. Ninety-nine (69%) reported having ethics consultation services. Freestanding children's hospitals (28% of all hospitals) were more likely to report the presence of PECS (P <.001), making up 41% of hospitals with a PECS. The median number of staffed beds was 203 (25(th) quartile 119, 75(th) quartile 326) for those with PECS compared with 80 for those without (25(th) quartile 40, 75(th) quartile 121). Facilities with palliative care, higher trauma ratio, intensive care, and comprehensive programs were more likely to have PECS. Academic affiliation was associated with PECS presence (P <.001). Settings associated with skilled nursing facilities or long-term care programs were not more likely to have PECS. Hospitals designated as federally qualified health centers (P = .04) and accountable care organizations (P = .001) were more likely to have PECS. CONCLUSIONAlthough PECS function as formal means to clarify values and mitigate conflict, one-third of children's hospitals lack PECS. Future research is needed to understand barriers to PECS and improve its presence.

Keyword:

HOSPICE CARE

PROVISION

HOSPITALS