Monday, May 02, 2005

Advanced Directives and Code Status

Katie Heldt and I have been working on guidance for Emergency Department Physicians about advanced directives in the ED, particularly their role in discussing the matter with the patient prior to admission. Here's an example of an explanatory memo:

The Emergency Department (ED) registration clerk will inquire (as is mandated by federal law) if the patient has an advanced directive. If the patient doesn’t have an advance directive it will be noted in the chart.

If the patient is to be admitted and the patient is older than 65 years of age, the Emergency Department Physician (EDP) will present a packet of information prepared by (Hospital) that pertains to advanced directives and will offer to discuss the matter

All patients admitted from the ED will use a standard set of orders. These orders will include a checkbox notation for “DNR” (Do Not Resuscitate), “Full Code”, and “CPR Only”. The EDP will guide the patient/family through choosing an option for the admission and indicate that the patient’s Primary Care Practitioner will discuss the matter further when they conduct rounds in the AM.


At 7:47 PM, Blogger Dr. Kenneth Schultheis said...

The EDP's role in this effort should be limited to providing the information ONLY! During the acute phase ED visit is not the time to be discussing this issue. The patient's medical circumstance may not be fully known nor appreciated, not only by the EDP, but as importantly by the patient and family. Additionally, EDP's typically have other pressing demands, including other patients in the department.

The responsibility for this discussion rests with the PCP AND NO ONE ELSE, and should either occur at a point in time prior to the patient's hospitalization (the preferred circumstance) or at some point during the hospitalization after the patient and family have had an opportunity to fully comprehend the patient's medical circumstance, including the consequences of any individual or jointly made decisions they elect to make in regard to completing an advanced directive.


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