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.