Table 3. Summary of Components of Institutional Management
Strategies
Component 1: Advance identification and notification of anticipated COs
• Institutional mechanisms should promote prospective identification and
notification of potential COs by clinicians.
Component 2: Timely evaluation of COs
• The institution should implement a clear mechanism for a timely impartial third-
party evaluation of COs.
Component 3: Disclosure of medical options and provision of uninterrupted
medical care
• The institution should identify mechanisms to ensure the disclosure and the
uninterrupted provision of all legal, professionally accepted, and otherwise available
medical options.
Component 4: Protocol to facilitate transfer of care
• A transfer of care is the optimal mechanism for accommodating COs. The
institution should prospectively identify mechanisms for the safe and timely transfer
of care of the patient.
Component 5: Process for appeals
• The institution should delineate a mechanism for the timely and transparent evaluation
of appeals from patients, surrogates, and clinicians.
Component 6: Consequences for clinicians who refuse to provide a medical service
when a CO cannot be accommodated
• Clinicians who refuse to provide a legal, professionally accepted, and otherwise available
medical service without a formal CO accommodation may be subject to any applicable
institutional or legal consequences.
Component 7: Periodic review of CO cases
• The institution should establish a mechanism for the routine periodic retrospective
review of COs.
Management
