Ethics consultation volume at U.S. children's hospitals: A cross-sectional survey

Background: There is growing interest in credentialing hospital ethicists. Consult volume is being incorporated into credentialing criteria, although few data supporting this approach are available. The objectives of this study were to (1) measure the consult volume at U.S. children's hospitals, (2) identify the factors associated with consult volume, and (3) determine the relevant views of pediatric ethics consultants. Methods: The study population was U.S. children's hospitals with at least 100 beds that have a dedicated pediatric ethics consultation service (n = 56). The study was a cross-sectional, Internet-based survey of the best informants at these hospitals. Results: The response rate was 79% (44/56). The median number of consults conducted per year was 8 (range 1–57). Factors associated with consult volume adjusted for hospital beds were salary support of the consultation service (p = 0.002); the frequency of didactic ethics lectures (p = 0.001); the frequency of ethics consultants informally visiting the hospital wards (p = 0.007), the number of educational services provided (p = 0.003); the frequency of ethics rounds (p = 0.02); and the use of a call schedule (p = 0.003). Seventy-nine percent believed that quality of ethics consultation is related to the number of consults performed, and 68% supported minimum standards for consult volume in a credentialing policy. Overall, 64% expressed support for credentialing of hospital ethicists. Conclusions: Educational and outreach efforts by hospital ethics committees, as well as salary support for hospital ethicists, are associated with increased pediatric ethics consultation volume at U.S. children's hospitals.