Unit-Based Ethics Rounds
Because it is so difficult for front-line staff to leave their units to attend case conferences or tutorials, the Ethics Support Service has steadily expanded unit-based ethics rounds. These informal discussions are designed to provide a forum where the staff can reflect on a patient situation that contained ethical issues. Some of the recurrent themes of ethics rounds include conflicts over the goals-of-care, approaches to end-of-life discussions with families, issues of interdisciplinary team collaboration, "futile" treatment, and challenges of providing culturally-appropriate care to patients and families.
An ethicist from the Ethics Support Service facilitates these discussions and provides support in thinking about how to approach ethical decision-making when those involved are morally conflicted, including brainstorming about courses of action that may be helpful. These might include gathering the clinical team for a family meeting; requesting a formal ESS consultation; suggesting a palliative care consult; or involving psychiatric nurse liaison, Pastoral Services, Patient Relations, Risk Management, or the Legal Department.
Rounds are designed to be interdisciplinary and to foster team collaboration in difficult situations. Nurses, physicians, social workers, students, and other ancillary staff are regular participants. Over the course of the year, combined attendance at unit-based rounds was nearly 1,000 participants.
