LOS decreases after ethics program begun

A study conducted on the effects of the four-year-old ethics grand rounds program at Boston’s Deaconess Beth Israel Hospital found that for patients who died, length of stay in the surgical intensive care unit (SICU) declined 46% in 1994 compared with 1990. The results also indicated that the severity of illness did not vary significantly over the four years.

After operating the program for four years, Deaconess researchers designed a study to determine if the program had any measurable effect on patient care management in the hospital. The outcomes measures of interest were documentation of patient and family contacts in the medical record and length of stay trends. These outcomes were assessed for all patients in the SICU during the years from 1990 to 1993.

Overall, the total number of days for 64 dying patients was 1,003 in 1993, compared with a total of 2,028 days for 73 dying patients in 1990. At an average cost of $1,763 per day, the savings exceeded $1.75 million (though researchers stressed that cost containment was not a goal of the ethics grand rounds program).

There was also evidence that for patients who spent more than 30 days in the SICU, communication with patients and family was occurring more frequently and earlier in the patient’s course of treatment. "During this time, the SICU culture changed for the better," Deaconess researchers wrote in the journal Surgery in August 1995.

"Patients and families become more involved along with surgical staff in patient/family meetings and in critical, ethical decisions. We conclude that our educational intervention met its objective, which was to integrate practical ethical issues into surgical resident clinical practices resulting in better patient care that was cost-effective."

Begun in 1990, the ethics grand rounds program at Deaconess Beth Israel Hospital included every resident physician in the SICU attending four 60-minute discussion groups. Led by attending physicians and nursing directors, the groups discussed and debated case histories based on recent patient profiles from the hospital’s SICU.