School of Medicine and Health Sciences Poster Presentations

Title

Care Conundrum in the ED: The Gap Between Clinician Awareness and Patient Expectations about Advance Directives

Document Type

Poster

Keywords

Advance Directives; palliative; emergency; expectations

Publication Date

Spring 2017

Abstract

Background: Initiation of the palliative process in the ED with preliminary advance care discussions contribute to reducing the length of hospital stay, overall cost, ED recidivism, ICU utilization, and improving patient and caregiver satisfaction.

Objectives: To assess if elderly ED patients have advance care directives, to identify the patterns and incidence of advance care discussions in the ED between patients and providers, and to gain an understanding of patients' perceptions and expectations of such discussions.

Methods: Trained research assistants surveyed ED patients (Emergency Severity Index 2 or 3) over age 65 or their caregivers in an urban university hospital. Patients were asked about advance care planning documents and whether they had discussed goals of care with ED staff, primary care physicians, or their families.

Results: 248 out of 426 patients completed surveys. 89% of patients lived independently and 4% resided in assisted living facilities. 42% of patients reported completing an advance care document; with 62% of these located at their home. 23% reported previous advance care discussions with their primary care physician and 57% had discussions with their family. 82% of patients thought ED providers should know about their end of life wishes, but only 40% wanted to talk to ED clinicians about advance care planning. 7% of patients reported that EM physicians and nurses asked about advance directives.

Conclusions: Most older ED patients expect emergency clinicians to be aware of their care preferences in the event of a critical illness yet over half of patients do not have an advance care document and most are not asked about their advance care preferences by emergency physicians and nurses. The large gap between the desire to have their preferences known and any systematic way to discuss or record these desires suggests the need for system improvements (better communication of advance directives across care systems) and more targeted discussions by ED clinicians. The ED may be a place to initiate advance care discussions in patients who have not prepared an advance directive. The limited awareness that ED clinicians have of patients' advance directives suggests that future studies should explore barriers to advance care planning in the ED.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Comments

Poster to be presented at GW Annual Research Days 2017.

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Care Conundrum in the ED: The Gap Between Clinician Awareness and Patient Expectations about Advance Directives

Background: Initiation of the palliative process in the ED with preliminary advance care discussions contribute to reducing the length of hospital stay, overall cost, ED recidivism, ICU utilization, and improving patient and caregiver satisfaction.

Objectives: To assess if elderly ED patients have advance care directives, to identify the patterns and incidence of advance care discussions in the ED between patients and providers, and to gain an understanding of patients' perceptions and expectations of such discussions.

Methods: Trained research assistants surveyed ED patients (Emergency Severity Index 2 or 3) over age 65 or their caregivers in an urban university hospital. Patients were asked about advance care planning documents and whether they had discussed goals of care with ED staff, primary care physicians, or their families.

Results: 248 out of 426 patients completed surveys. 89% of patients lived independently and 4% resided in assisted living facilities. 42% of patients reported completing an advance care document; with 62% of these located at their home. 23% reported previous advance care discussions with their primary care physician and 57% had discussions with their family. 82% of patients thought ED providers should know about their end of life wishes, but only 40% wanted to talk to ED clinicians about advance care planning. 7% of patients reported that EM physicians and nurses asked about advance directives.

Conclusions: Most older ED patients expect emergency clinicians to be aware of their care preferences in the event of a critical illness yet over half of patients do not have an advance care document and most are not asked about their advance care preferences by emergency physicians and nurses. The large gap between the desire to have their preferences known and any systematic way to discuss or record these desires suggests the need for system improvements (better communication of advance directives across care systems) and more targeted discussions by ED clinicians. The ED may be a place to initiate advance care discussions in patients who have not prepared an advance directive. The limited awareness that ED clinicians have of patients' advance directives suggests that future studies should explore barriers to advance care planning in the ED.