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UNC CCSP and Palliative Care Grand Rounds
May 30, 2018 @ 8:00 am - 9:00 am
Please join us; Wednesday, 05/30/18 at 8am, Patient Family Resource Center Conference Room (Ground Floor, North Carolina Cancer Hospital)
Hosted by the UNC Comprehensive Cancer Support Program (CCSP) and the UNC Palliative Care Program
Presenters: Sara Scarlet, MD and Margaret Walsh, PhD
Title: Clinical Inertia in Critical Care: Lessons from Ethics Consultations; Arthurs: Margaret Waltz, Sara Scarlet, Jean Cadigan, Casey Olm-Shipman, Arlene Davis
Abstract: Clinical inertia literature often focuses on its classic definition: the failure of clinicians to initiate and intensify therapies (Phillips et al. 2001). Yet clinical inertia can also include clinicians’ failure to stop or reduce therapies (Giugliano and Esposito 2011). Here, we examine how both types of inertia operate in critical care units (ICUs) in the context of ethics consultations. Our analysis relies on data from two sources. First, we use observations of ethics case discussions in medical and pediatric ICUs to determine how clinicians talk about inertia, such as feeling that their “hands are tied,” that interventions are “past futility,” or that there has been “lack of progress” in decision making. These descriptions often revolve around feelings of powerlessness, poor communication, frustrations with surrogate decision makers, and questions about appropriateness of interventions. Second, we utilize a retrospective chart review of ICU patients for whom ethics consultations have been requested. These data include demographic characteristics and characteristics of illness (mechanical ventilation, inotropic therapies, presence of delirium), as well as possible indicators of inertia such as code status, identification of a surrogate, and documentation of family meetings or advance planning. We examine whether and how these indicators of inertia have been altered (or not) post consultation. In doing so, our work informs the understudied phenomenon of inertia in critical care (Jolley et al. 2014) and highlights how the ethics consultation may act as an intervention to help eliminate inertia and change the course of clinical care within this context.
Bio: Sara Scarlet, MD, is a fifth year general surgery resident. This summer, she will complete a Masters in Public Health from the Gillings School of Global Public Health and a fellowship in Surgical Ethics at the MacLean Center for Clinical Medical Ethics at the University of Chicago. Sara has been an active member of the Hospital Ethics Committee (HEC) since July 2016 and has served as a lead consultants since July 2017. Her interests include moral distress among physician trainees and the intersections of the health care and criminal justice systems.
Bio: Margaret Walsh, PhD, is a Postdoctoral Research Associate in the Center for Genomics and Society in the Department of Social Medicine. She received her PhD in Sociology from Case Western Reserve University where she researched patients’ experiences of waiting in medical waiting rooms and how medical institutions structure patients’ time. Her research interests include the ethical and social implications of genomic technologies; (bio)medicalization; and the performance of emotional labor among medical care providers. She is currently working on ethical and social implications of preventive genomic screening for adults, including return of results in the GeneScreen project.
We offer: Accreditation
The School of Medicine of the University of North Carolina at Chapel Hill is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Continuing Medical Education Statement: The School of Medicine of the University of North Carolina at Chapel Hill designates this live activity for a maximum of 8.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Other health professionals will receive a certificate of attendance from an AMA PRA Category 1™ activity. These certificates are accepted by the NC Boards for physician assistants, nurse practitioners, nurses, and respiratory therapists. Other health care providers may also be able to use these certificates, depending on their particular license requirements. (License requirements are subject to change. Participants should check with their licensing boards for specific questions. UNC and its partners are not responsible for changes in license requirements.)