Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests
Abstract Background Decision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding...
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| Format: | Article |
| Language: | English |
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BMC
2021-06-01
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| Series: | BMC Medical Ethics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12910-021-00654-y |
| _version_ | 1819145722102022144 |
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| author | Louise Milling Lars Grassmé Binderup Caroline Schaffalitzky de Muckadell Erika Frischknecht Christensen Annmarie Lassen Helle Collatz Christensen Dorthe Susanne Nielsen Søren Mikkelsen The Danish Cardiac Arrest Registry Group |
| author_facet | Louise Milling Lars Grassmé Binderup Caroline Schaffalitzky de Muckadell Erika Frischknecht Christensen Annmarie Lassen Helle Collatz Christensen Dorthe Susanne Nielsen Søren Mikkelsen The Danish Cardiac Arrest Registry Group |
| author_sort | Louise Milling |
| collection | DOAJ |
| description | Abstract Background Decision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers’ documentation. Methods This was a Danish nationwide retrospective observational study of out-of-hospital cardiac arrests from 2016 through 2018. After an initial screening using broadly defined inclusion criteria, two experienced philosophers performed a qualitative content analysis of the included medical records according to a preliminary codebook. We identified ethically relevant content in free-text fields and categorised the information according to Beauchamp and Childress’ four basic bioethical principles: autonomy, non-maleficence, beneficence, and justice. Results Of 16,495 medical records, we identified 759 (4.6%) with potentially relevant information; 710 records (4.3%) contained ethically relevant information, whereas 49 did not. In general, the documentation was vague and unclear. We identified four kinds of ethically relevant information: patients’ wishes and perspectives on life; relatives’ wishes and perspectives on patients’ life; healthcare professionals’ opinions and perspectives on resuscitation; and do-not-resuscitate orders. We identified some “best practice” examples that included all perspectives of decision-making. Conclusions There is sparse and unclear evidence on ethically relevant information in the medical records documenting resuscitation after out-of-hospital cardiac arrests. However, the “best practice” examples show that providing sufficient documentation of decision-making is, in fact, feasible. To ensure transparency surrounding prehospital decisions in cardiac arrests, we believe that it is necessary to ensure more systematic documentation of decision-making in prehospital resuscitation. |
| first_indexed | 2024-12-22T13:02:32Z |
| format | Article |
| id | doaj.art-920c9675e4d14e0c9bd1741b6418c944 |
| institution | Directory Open Access Journal |
| issn | 1472-6939 |
| language | English |
| last_indexed | 2024-12-22T13:02:32Z |
| publishDate | 2021-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Ethics |
| spelling | doaj.art-920c9675e4d14e0c9bd1741b6418c9442022-12-21T18:24:57ZengBMCBMC Medical Ethics1472-69392021-06-0122111010.1186/s12910-021-00654-yDocumentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrestsLouise Milling0Lars Grassmé Binderup1Caroline Schaffalitzky de Muckadell2Erika Frischknecht Christensen3Annmarie Lassen4Helle Collatz Christensen5Dorthe Susanne Nielsen6Søren Mikkelsen7The Danish Cardiac Arrest Registry Group8Prehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University HospitalPhilosophy, Department for the Study of Culture, University of Southern DenmarkPhilosophy, Department for the Study of Culture, University of Southern DenmarkCentre for Prehospital and Emergency Research, Aalborg University Hospital, Aalborg UniversityEmergency Medicine Research Unit, Odense University HospitalThe Danish Clinical Quality Program, National Clinical RegistriesDepartment of Infectious Diseases, Sub-department of Immigrant Medicine, Odense University HospitalPrehospital Research Unit, Department of Anaesthesiology and Intensive Care, Odense University HospitalThe Danish Clinical Quality Program, National Clinical RegistriesAbstract Background Decision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers’ documentation. Methods This was a Danish nationwide retrospective observational study of out-of-hospital cardiac arrests from 2016 through 2018. After an initial screening using broadly defined inclusion criteria, two experienced philosophers performed a qualitative content analysis of the included medical records according to a preliminary codebook. We identified ethically relevant content in free-text fields and categorised the information according to Beauchamp and Childress’ four basic bioethical principles: autonomy, non-maleficence, beneficence, and justice. Results Of 16,495 medical records, we identified 759 (4.6%) with potentially relevant information; 710 records (4.3%) contained ethically relevant information, whereas 49 did not. In general, the documentation was vague and unclear. We identified four kinds of ethically relevant information: patients’ wishes and perspectives on life; relatives’ wishes and perspectives on patients’ life; healthcare professionals’ opinions and perspectives on resuscitation; and do-not-resuscitate orders. We identified some “best practice” examples that included all perspectives of decision-making. Conclusions There is sparse and unclear evidence on ethically relevant information in the medical records documenting resuscitation after out-of-hospital cardiac arrests. However, the “best practice” examples show that providing sufficient documentation of decision-making is, in fact, feasible. To ensure transparency surrounding prehospital decisions in cardiac arrests, we believe that it is necessary to ensure more systematic documentation of decision-making in prehospital resuscitation.https://doi.org/10.1186/s12910-021-00654-yBioethicsCardiac arrestResuscitationEmergency medical servicesDecision-making |
| spellingShingle | Louise Milling Lars Grassmé Binderup Caroline Schaffalitzky de Muckadell Erika Frischknecht Christensen Annmarie Lassen Helle Collatz Christensen Dorthe Susanne Nielsen Søren Mikkelsen The Danish Cardiac Arrest Registry Group Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests BMC Medical Ethics Bioethics Cardiac arrest Resuscitation Emergency medical services Decision-making |
| title | Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests |
| title_full | Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests |
| title_fullStr | Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests |
| title_full_unstemmed | Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests |
| title_short | Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests |
| title_sort | documentation of ethically relevant information in out of hospital resuscitation is rare a danish nationwide observational study of 16 495 out of hospital cardiac arrests |
| topic | Bioethics Cardiac arrest Resuscitation Emergency medical services Decision-making |
| url | https://doi.org/10.1186/s12910-021-00654-y |
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