This study assessed burnout within a large Health Maintenance Organization. Primary care physicians and one psychiatric clinic staff were studied. The Maslach Burnout Inventory was used to develop frequency data in the areas of emotional exhaustion, depersonalization, and personal achievement. Among the primary care physicians, moderate emotional exhaustion, and depersonalization were found. Personal achievement was high. Among the psychiatric staff, high emotional exhaustion and depersonalization were found. Again, personal achievement was high. The entire professional group, with the one exception, was significantly higher in emotional exhaustion, depersonalization, and personal achievement than Maslach's normative sample. Psychiatrists and social workers had significantly higher scores on depersonalization than the primary care physicians or psychologists. High burnout in a Health Maintenance Organization setting suggests that managed health care providers may be more prone to burnout than fee-for-service practitioners. Several suggestions were made for such organizations to help alleviate burnout in their staffs.

extremely obese should enquire about mental health, parenting, development and psychosocial factors, and make appropriate referrals. Childhood obesity often indicates family distress and unmet need including important child mental health difficulties. G495 INNOVATIVE TREATMENTS FOR CHILDREN: A SINGLE CENTRE REVIEW OF CLINICAL ETHICS COMMITTEE DISCUSSIONSHL Turnham, T Radcliffe, J Brierley. Paediatric Intensive Care, Great Ormond Street Hospital, London, UK 10. 1136/archdischild-2015-308599.448 Aims Lord Saatchi's proposed Medical Innovation Bill (MIB) has received widespread media and public interest. The Bill aims to encourage doctors to try novel treatments for those reaching the limit of standard therapy, promising protection from sanctions e.g. prosecution.Innovative therapies (IT) are a relatively common undertaking in the rare and occasionally unique diseases encountered in children's hospitals, children are not discussed in the proposed Bill.Brierley and Larcher proposed an ethical framework to review IT in children and we describe cases reviewed by our Clinical Ethics Committee (CEC) since introducing this approach. Methods Tertiary paediatric hospital CEC transcripts regarding IT proposals 2011-14 reviewed. Discussion In four years the CEC reviewed 13 IT cases, 6 were urgent and reviewed by rapid response committee. Proposals were presented by 11 different paediatric specialities -9 single patient specific, 4 relevant to multiple patients.The CEC consisted of at least one medical, one lay member and a member with a higher degree in medical ethics. A legal adviser attended 7 meetings and a member of the hospital spiritual team 8. Minimum of 5 CEC members at review (range 5-13). Families attended all single patient reviews.In all cases in line with the framework medical teams justified the scientific basis for treatment (1) and provided second opinions of external specialists in the field (2). The clear informed consent to the specific proposal by the child and/or those with parental responsibility (3) were obtained, including full knowledge of alternative possibilities e.g. palliative care.(4) The entire local, and where relevant external referring, teams agreed this treatment was an appropriate course.(5) Wider issues such as burdens of treatment for the child and family as a whole (6) together with funding implications for treatment (7) and other resources e.g. PICU were also discussed. An explicit guarantee to disseminate the result of IT whatever the outcome from the team was made. Conclusion Our CEC offers medical teams the opportunity to have innovative therapies reviewed by a multidisciplinary group using a published framework. Innovation is already happening and we are not persuaded the MIB is necessary, or protection from prosecution sensible. Aim We present a 6 day old boy who suffered femoral arterial thrombosis. Parents are Muslim and disagree with the use of Heparin, as it contains pork-derived gelatine. We explore medico-religious conflict between Muslim parents and health-care professio...

Background and aims Increasing interventions for children with complex problems are leading to moral dilemmas for both professionals and families. We reviewed support to a children's hospital from a bespoke Clinical Ethics Committee (CEC): 20 voluntary members, 1 part-time administrator. (Funded GOSH Children's Charity) Membership: ethics/law, lay/parents, nurses, paediatricians, anaesthetists, surgeons, social care, psychologists, patient advocacy and managers. Aim Describe activity and case review change from full CEC <6 weeks wait to Rapid Responses (RR)-1-5 days. Methods Retrospective CEC database and minutes review March 2013-14 and same 2009-10. Results Cases: 2013-14: 14 cases-1 full CEC and 13 RR, 3 included external hospitals-1 via videoconference. Parents attended 12. Themes: withdrawal life-sustaining therapy: 3; limitation life-sustaining therapy e.g. ECMO: 5; innovative therapies: 4; capacity/consent: 1, complex dilemma 1. 2009-10: 7 cases-5 cases CEC, 2 RR. Parents 2. Themes: LLST 3, innovative 2, WLST 2. 3 meetings general ethical aspects of therapyenzyme replacement provision, arteriolysis/thrombolysis for limb salvage and mitochondrial ethical pathway. Education: 1PhD, 2 BSc and 8 SSC medical students-leading to 8 presented abstracts and 2 publications. Lecture series for hospital/other staff. Paediatric Ethics Meeting 'Making Tomorrows People'; 2 CEC education 'away days.' (Judiciary and academic philosophers). Media: Participation national (BBC) TV and radio ethics programmes and print media. Conclusions Ethics support to a variety of specialist teams and families is increasing. Support now provided for other hospitals with local reviews or videoconference support. Increasingly prevalent urgent ethics issues have lead to RR being preferred.