Evidence map›Paper›PMID 40753248›Full record

Trial reportBMC medical ethics2025

Impacts of mandatory clinical ethics consultation on resource utilization and ethical conflicts in critically ill patients: a comparison between medical and surgical intensive care units.

Yen-Ko Lin, Chao-Wen Chen, Yung-Sung Yeh, Chia-Ju Lin, Yu-Wen Huang, Yu-Chih Lin, Chau-Chyun Sheu

Registry-linked trialAbstract readComparative StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC medical ethics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04926610 (The Effect of Proactive Clinical Ethics Consultations on End-of-life Care of the Critically Ill in the Intensive Care Settings), which is not on this map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04926610 naunknown statusnot on this map

The Effect of Proactive Clinical Ethics Consultations on End-of-life Care of the Critically Ill in the Intensive Care Settings

TypeinterventionalSponsorKaohsiung Medical University Chung-Ho Memorial HospitalRan2014 to 2023Enrolled224ConditionsProactive Clinical Ethics Consultation, the Critically IllArmsproactive clinical ethics consultation
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Yen-Ko LinDivision of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Chao-Wen ChenDivision of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Yung-Sung YehDivision of Trauma and Surgical Critical Care, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Chia-Ju LinCollege of Nursing, Kaohsiung Medical University, Kaohsiung, 807, Taiwan. chiaju@kmu.edu.tw.
Yu-Wen HuangDepartment of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Yu-Chih LinDivision of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Chau-Chyun SheuDepartment of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Funding

Kaohsiung Medical University Chung-Ho Memorial Hospital KMUH109-9R31Ministry of Science and Technology, Taiwan MOST 113-2410-H-037-013-MY2
6 · The paper itself

Abstract

backgroundMandatory clinical ethics consultation (CEC) is initiated under specific circumstances when required by institutional policies. Medical and surgical intensive care units (ICUs) have various characteristics. Studies on whether mandatory CEC have different impacts on medical and surgical ICUs are limited. This study aimed to investigate the impacts of mandatory CEC on resource use and ethical conflicts as well as family member satisfaction regarding critically ill patients in medical and surgical ICUs and their predicting factors.

resultsThis combined retrospective and prospective cohort study was conducted at a tertiary academic university-affiliated medical center. Patients admitted to the adult ICUs and had CEC between January 1, 2013, and December 31, 2020, were eligible. A total of 1,150 adult patients were included, with 822 in the medical and 328 in the surgical ICU. After the implementation of mandatory CEC policy, resource use in both ICUs deceased biannually. Medical ICU has significantly longer total length of stay (LOS), days of ventilator use, and days from ICU admission to ethics consultation than surgical ICU. Advanced cancer and the episode of cardiac arrest mainly predicted ICU LOS and resource use in the medical ICU, whereas the Glasgow Coma Scale (GCS) score was the main predicting factor for surgical ICU. Secular trends for incidence rates of ethical conflicts decreased biannually in both ICUs. In general, higher incidence rates of ethical conflicts were observed in the surgical ICU. The predicting factors for ethical conflicts in the medical ICU included age, patients with advanced cancer, patients who received inotropes or vasopressors, and the GCS score, whereas in the surgical ICU, the marital status and GCS score were the main predicting factors. Family members in both ICUs were highly satisfied with the CEC team.

conclusionMedical and surgical ICUs exhibited different impacts on resource use and ethical conflicts after the implementation of mandatory CEC policy. Our results provide CEC and clinical teams with guidelines to approach the distinct issues within various specialties. The institution should consider implementing mandatory CEC policy and developing special educational and training programs for various specialties to provide the best quality of end-of-life care in the ICUs.

trial registrationThe ClinicalTrials.gov Identifier is NCT04926610.

Indexed as

Critical CareCritical IllnessEthics ConsultationHealth ResourcesIntensive Care UnitsAdultAgedFemaleHumansLength of StayMaleMiddle AgedProspective StudiesRetrospective StudiesEnd-of-life careIntensive care unitMandatory clinical ethics consultationWithdrawal of life-sustaining treatment

Identifiers

PMID40753248
PMCPMC12318408

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.